NOMINATION FORM
2016
Instructions:
1. Please fill out this nomination form completely and legibly.
2. Submit this original copy to the Metrobank Foundation, Inc. thru
your nearest Metrobank Branches in your area on or before
January 29, 2016
Attach here your latest
2”x2” ID colored photo.
It must be front, facial
close-up, with your
printed
name
&
signature at the back
of the photo.
I, ___________________________________________, is honored to nominate _________________________________________
(name of nominator)
(name of nominee)
to the 2016 Metrobank Foundation – Rotary Club of Makati Metro Search for The Outstanding Philippine Soldiers (TOPS). This
nomination is a tribute to his/her outstanding career accomplishments in the military profession and his/her exemplary dedication,
courage and selfless acts of gallantry in the service of our country and people.
_______________________________________
____________________________ __________________________________
Signature Over Printed Name of Nominator
Designation
Name of Unit / Organization
I. NOMINEE’S INFORMATION
Rank
Last
Serial Number:
Current Position:
First
Middle
Branch of Service:
Category Joining in:
Previous Rank:
❏ Commissioned
Officer
❏ Enlisted Personnel
Date entered
AFP: (mm/dd/yy):
Date of Last
Promotion:
Date of Birth
No. of Years in
active duty:
Place of Birth:
Age:
Field of Specialization:
Gender:
❏M ❏ F
(e.g. Ranger, Intelligence, etc.)
Religion:
Have you joined the Search for
TOPS before?
❏ YES ❏ NO
If, yes, in what year/s?_______
Have you been a Finalist in the
Search for TOPS before?
❏ YES ❏ NO
If yes, in what year/s?________
(mm/dd/yy):
Civil Status:
❏ Single ❏ Married
No. of
Children:
Name of Spouse:
❏ Legally Separated ❏ Others ________
Highest Educational Attainment / Name of School:
Course/Degree:
Year Graduated:
Are you due for schooling/training abroad for
the period of April 2016 – October 2016?
❏ YES ❏ NO
If yes, where & what type of schooling/
training?____________________________
Permanent Home Address (House No., Street, Barangay, Town or Municipality/City/Province):
Residence Phone #:
Mobile #:
Region:
Personal Email Address:
Current/Specific Unit Assignment: (please do not abbreviate)
City/ Municipality:
Province:
Region:
Complete Office Mailing Address/Base Camp Assignment:
Office Phone #:
Fax No:
Office Email Address:
II. CRIMINAL, CIVIL & ADMINISTRATIVE RECORD
Have you been CHARGED with any of the following offense
at any time before or during the time you joined the AFP?
Have you been CONVICTED of any of the following offense
at any time before or during the time you joined the AFP?
❏ Administrative ❏ Civil ❏ Criminal
____ YES
____ NO
❏ Administrative ❏ Civil ❏ Criminal
____ YES
____ NO
Status: ❏ Case Dismissed
❏ Pending
Status: ❏ Case Dismissed
❏ Pending
REPRODUCTION / PHOTOCOPYING OF THIS NOMINATION FORM IS AUTHORIZED
This may also be downloaded at http://www.mbfoundation.org.ph
IF YES, PLEASE PROVIDE DETAILS ON THE FOLLOWING IN A SEPARATE SHEET OF PAPER:
A. Type of Case (Administrative, Civil or Criminal)
B. Nature of Charge/Complaint (Frustrated Murder, Physical Abuse, etc.)
C. Date the charge/complaint was filed
D. Where the charge/complaint was filed (e.g., Commission on Human Rights, Ombudsman, AFP Inspector, General, etc.)
E. Circumstances surrounding the charge/complaint
F. Status/Final Resolution (Preliminary Investigation, Dismissed, etc.)
III. CERTIFICATION
This is to certify that I voluntarily submit myself to the rules of the Search. I agree to provide the supporting documents should I
qualify for the next phase of the Search or if I am requested by any of the authorized representatives of the organizers of the
Search.
I also certify that I am physically and mentally fit to undergo the evaluation process of the Search. In this regard, I hereby
exempt, discharge, release and free Metrobank, the Metrobank Foundation, Inc. and the Rotary Club of Makati Metro, their
respective directors/trustees, officers, employees, members and staff, affiliates and/or subsidiaries, and the judges of the Search,
from any claim or liability arising from my participation in the Search.
I hereby certify to the best of my knowledge and belief that all the information contained in this form is true and correct. I am
aware that any willful misrepresentation or misdeclaration of facts or any untruthful statement or information stated herein shall be
used as basis for my disqualification or the withdrawal of any award slot.
Signed on this day (date) ___________________ at (place) __________________________________________.
_____________________________________________
Rank/Complete Name of Nominee
________________________________________
Signature
! IMPORTANT DATES TO REMEMBER:

January 29, 2016
Deadline of submission of Nomination Form to nearest Metrobank Branches

March 22, 2016
Deadline of submission of supporting and required documents (1 printed copy containing all original files such
as clearances, endorsements, etc. and 1 CD, properly labeled, containing electronic copies of supporting
documents) to nearest Metrobank Branches (please include Affidavit of Undertaking)
WHERE DID YOU LEARN ABOUT THE SEARCH FOR TOPS? (Check as many as applicable)
___ TOPS posters/flyers
___ Metrobank Foundation Website
___ TOPS Facebook page
___ AFP/PA/PN/PAF Publications/Website
___ Radio / TV announcement
___ Newspaper announcement
___ AFP Unified Commands
___ Peers in the AFP
___ TOPS Information Campaign
___ TOPS Awardee
Awardee’s name: ___________________________
Others: ___________________________________
(For the Nominator): Please discuss in brief, what makes the nominee deserving of the distinction of The Outstanding
Philippine Soldiers (TOPS)?
________________________________
Signature over Printed Name of Nominator
FOR
MORE DETAILS:
Contact ThirdOF
Salang
Hero Hernandez
898-8757, (0922) 803-3948 or email
REPRODUCTION
/ PHOTOCOPYING
THIS or
NOMINATION
FORMatIS(02)
AUTHORIZED
at third.salang@metrobank.com.ph.
You
may also visit our website at www.mbfoundation.org.ph.
This may also be downloaded
at http://www.mbfoundation.org.ph