BOIS Form 001 Revised 2017
1X1
ID Picture
Republic of the Philippines
Department of the Interior and Local Government
DILG-NAPOLCOM Center, EDSA corner Quezon Avenue, Quezon City
BARANGAY OFFICIAL’S INFORMATION SHEET
REGION :
PROVINCE
:
CITY/MUN
:
BARANGAY
:
ELECTIVE AND APPOINTIVE POSITION
Punong Barangay
Barangay Treasurer
Sangguniang Barangay Member
Barangay Secretary
Rank (1, 2, 3, 4, 5, 6, 7)
Relationship with the Appointing Authority: _______________
SK Chairperson
IPMR
SK Member
other Appointive Barangay Official:
TERM IN THE PRESENT POSITION
1st
2nd
_____________________________
3rd
PERSONAL INFORMATION
(Last Name)
(Birth Date: mm/dd/yyyy)
(Suffix e.g. Jr., I, II,III)
(First Name)
(Birth Place)
(Sex)
(Middle Name)
(Civil Status)
(Religion)
(Residence Address)
(Mobile Number)
(Residence Telephone No.)
(Barangay Hall Telephone Number)
HIGHEST EDUCATIONAL ATTAINMENT:
ELEMENTARY
HIGH SCHOOL
Please specify:
Graduate
OCCUPATION:
(E-mail Address)
COLLEGE
POST GRAD
VOCATIONAL
Under Graduate
HONORARIUM:
BENEFICIARIES:
NAME
DATE OF BIRTH
RELATIONSHIP
1.
2.
3.
4.
5.
I hereby certify that the above information are true and correct to the best of my knowledge.
(Signature Over Printed Name)
(Date Accomplished)
Verified and validated by:
CD/CLGOO/MLGOO
(Signature Over Printed Name)
Date