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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
2 nd
_____________________________
3rd
PERSONAL INFORMATION
(Last Name)
(Suffix e.g. Jr., I, II,III)
(Birth Date: mm/dd/yyyy)
(Birth Place)
(First Name)
(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.
