BOIS Form 001 Revised 2017

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 : 2 CITY/MUNICIPALITY : SOLANA

PROVINCE : CAGAYAN BARANGAY : MADDARULUG

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) (Suffix e.g. Jr., I, II, III) (First Name) (Middle Na

(Birth Date: mm/dd/yyyy) (Birth Place) (Sex) (Civil Status) (Religion)

(Residence Address) (Residence Telephone No

(Mobile Number) (Barangay Hall Telephone Number) (E-mail Address)

HIGHEST EDUCATIONAL ATTAINMENT: ELEMENTARY HIGH SCHOOL COLLEGE POST GRAD

Please specify: Graduate Undergraduate

OCCUPATION: HONORARIUM:

BENEFICIARIES:
NAME DATE OF BIRTH RELATIONSH
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:

CO/CLGOO/MLGOO Date
 1X1
epublic of the Philippines ID Picture
f the Interior and Local Government
er, EDSA corner Quezon Avenue, Quezon City

FFICIAL'S INFORMATION SHEET

AND APPOINTIVE POSITION

Relationship with the Appointing Authority : ____________________

SONAL INFORMATION

(Middle Name)

(Religion)

(Residence Telephone No.)

(E-mail Address)

POST GRAD VOCATIONAL

RELATIONSHIP
(Date Accomplished)

Date