DILG Form

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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 : V______ Municipality : Manito


Province :__Albay_____ Barangay : TINAPIAN
ELECTIVE AND APPOINTIVE POSITION
Position :

PERSONAL INFORMATION
Last Name: First Name: Middle Name:___________
Birth Date :_______________
BirthPlace:______________________________________________________
Sex:___________
Civil Status :_________________________
Religion : _________________
Residential Address : _________________________________________________________________
Mobile Number : _______________________________
Highest Educational Attainment :_____________________________________________
Occupation : ____________________________________
Honorarium :______________________
BENIFICIARIES :
NAME DATE OF BIRTH RELATIONSHIP

1. _____________________________ ____________________
______________________
2. _____________________________ ____________________
______________________
3. _____________________________ ____________________
______________________
4. _____________________________ ____________________ ______________________

I hereby certify that the above information are true and correct to the best of my knowledge.

______________________________ ___________________
(Signature Over Printed Name) (Date Accomplised)

Verified and Validated by:

_______________________
MLGOO
(Signature Over Printed Name)

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