CTRD-NBOO-EDPS-BF2010-003B

BARANGAY OFFICIALS INFORMATION SHEET

Region: ________________
Province: _________________

City/Municipality: __________________
Barangay: __________________________

I. PERSONAL INFORMATION
Name: __________________________________

________

(First Name)

Date of Birth: ____________________________

MM/DD/YYYY

Sex:

_________________________________ ________________

MI

(Last Name)

(Ext.)

Place of Birth: _________________________________________________

Male
Female

Civil Status:

Highest Educational Attainment: :

Elementary
High School

Single
Married

College
Graduate Studies

Widow/er
Separated
Vocational

Profession/Occupation: __________________________________________________________________________________
Residence Address:
__________________________________________________________________________________
Contact Numbers:
Res. Tel. No. _________________________________
Cellphone No. _________________________________

Barangay Hall Tel. No. ____________________________

Beneficiaries:
Name

Date of Birth

Relationship

1.
2.
3.
4.
5.

II. POLITICAL INFORMATION

Elective Position:

Punong Barangay
Barangay Kagawad

TERM IN THE PRESENT POSITION:

Rank No.

1st

2nd

3rd

SK Chairman
DID YOU RUN AND WIN DURING PREVIOUS
BARANGAY ELECTION?
Yes

APPOINTIVE POSITION:
Brgy. Kagawad
Treasurer
Secretary

(DATE OF APPOINTMENT)

Election Period
October, 2010
October, 2007
July, 2002
May, 1997
May, 1994

No

(If yes kindly check)

PB

SBM

DATE OF ASSUMPTION TO OFFICE: __________________________________________

I HEREBY CERTIFY that the above information are true and correct to the best of my knowledge.
_____________________________
Date Accomplished

_____________________________
Signature over Printed Name