Data Captured Form: ND RD

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DATA CAPTURED FORM

2X2 PXCS
BASIC INFORMATION

*FULL NAME: ELLAZAR RODOLFO APGAO


LAST NAME FIRST NAME MIDDLE NAME
*AFP SERIAL NUMBER: PW-T10-000062 *BOS: PAF
*LAST NAME: ELLAZAR *FIRST NAME: RODOLFO
*MIDDLE NAME: APGAO EXTENSION NAME:
NICK NAME: POPOY *RANK: SSG
*CATEGORY: ACTIVE *STATUS: RESERVED
ND RD
*OFFICE ASSIGNMENT: 42 AFGR, 43 SQUADRON
*DESIGNATION: EXECUTIVE OFFICER *CLASSIFICATION: READY RESERVE
*GENDER: MALE
*AUTHORITY: AFPRG 117-573 17 JULY 2001
SO/GO NR UNIT DATE
*CIVIL STATUS: MARRIED *CITIZENSHIP: FILIPINO
*BIRTHDATE: JUNE 10, 1967 IDENTIFICATION MARK: LEFT EYE BROW
*BIRTHPLACE: CUYO, PALAWAN ETHNIC GROUP:
*RELIGION: ROMAN CATHOLIC *BLOOD TYPE: “A”
BODY BUILT: MEDIUM SIZE *HEIGHT: 5’6” (ft./m) *WEIGHT: 60 (kg)
*EYE COLOR: BLACK *HAIR COLOR: BLACK

 IF MARRIED
SPOUSE INFORMATION

*NAME: ERLINA T. ELLAZAR


*CONTACT NUMBER: 09999941315 *DATE OF BIRTH: 18 SEPTEMBER 1971
*DATE OF MARRIAGE: 25 MAY1994 *OCCUPATION:
*OCCUPATION: MIDWIFE
EMAIL
EMAILADDRESS:
ADDRESS: [email protected] *PLACE
*PLACEOF
OFBIRTH:
BIRTH: EL NIDO, PALAWAN
*PLACE OF MARRIAGE: MAYAOD, TENEGUIBAN, EL NIDO, PALAWAN
*ADDRESS: BGY. VILLA LIBERTAD, EL NIDO, PALAWAN

FAMILY BACKGROUND:
DEPENDENTS:
NAME B-DAY RELATIONSHIP ADDRESS
SITIO NASIGDAN,
MARC VENCENT T.
3 APRIL 1995 SON VILLA LIBERTAD, EL
ELLAZAR
NIDO, PALAWAN
16 SITIO NASIGDAN,
MA. LEAH T. ELLAZAR SEPTEMBER DAUGHTER VILLA LIBERTAD, EL
1999 NIDO, PALAWAN
PRESENT ADRESS:

:
*HOUSE NUMBER: *STREET: SITIO NASIGDAN
*SUBDIVISION: *BRGY: VILLA LIBERTAD
*TOWN: EL NIDO, PALAWAN *CITY: PUERTO PRINCESA CITY
*ZIP CODE: 5313

PREVIOUS ADDRESS:

HOUSE NUMBER: STREET: SITIO NASIGDAN


SUBDIVISION: : BRGY: VILLA LIBERTAD
TOWN: EL NIDO, PALAWAN CITY: PUERTO PRINCESA CITY
ZIP CODE: 5313

CONTACTS:

LANDLINE #: *MOBILE # 1: 09099348178


MOBILE #2: 09677905799 *EMAIL ADD:

CONTACT PERSON:

*CONTACT NAME: ERLINA T. ELLAZAR


*ADDRESS:
*ADDRESS: VILLA LIBERTAD, EL NIDO, PALAWAN
*RELATION: WIFE *MOBILE #: 09999941315
EMAIL ADD: [email protected]

ID CARD:

*TIN #: 148-596-534 *GSIS #: 4162 9802 5842 1766


*PAG- IBIG #: 1212-1180-0388 *PHILHEALTH #: 030513609856
*SSS #: 33-1451938-1

TARRIF SIZES:
BDU: BOOTS:
COMBAT 9W T-SHIRT:
BDU: SMALL SHORT CAP: 55”
T-SHIRT: SMALL SHORT: MEDIUM DRESS SHOES: SMALL

SOURCE OF ENLISMENT:
*AUTHORITY: AFPRG 117-573 17 JULY 2001
SO/GO NR UNIT DATE
STATEMENT OF SERVICE:

ASSIGNMENT/ REASSIGNMENT:
*RESERVIST COMPONENT: PAFR
*UNIT ASSIGNMENT: 42ND AFGR, 42 3RD SQUADRON
*MOBILIZATION CENTER: ARCEN
*TYPE: OPERATION *POSITION: EXECUTIVE OFFICER
DATE TO:
DATE FROM: 28 JANUARY 2010 DATE TO: AT PRESENT
*AUTHORITY: 13 HAFRC 21 JANUARY 2010
SO/GO NR UNIT DATE

PROMOTION:
*RANK: *RANK STATUS:
DATE FROM: DATE TO:

*AUTHORITY:
SO/GO NR UNIT DATE

ACTIVE SERVICE:
*TYPE: PURPOSE:
*AUTHORITY:
SO/GO NR UNIT DATE

EDUCATIONAL BACKGROUND:

CIVILIAN SCHOOLING:
EDUC LEVEL COURSE SCHOOL NAME DATE GRADUATED
PRIMARY ELEMENTARY MARINGIAN, 1981
ELEMENTARY
SCHOOL
SECONDARY HIGH SCHOOL PCAT, CUYO, 1990
PALAWAN
TERTIARY DRIVING NARRA INSTITUTE 23 MARCH 2011
AUTOMOTIVE OF TECHNICAL
SERVICING EDUCATION
GRADUATE
SCHOOL

BOARD ELIGIBILITY:

*TYPE OF LICENSE:
DATE OF
DATE OF EXAMINATION:
EXAMINATION:
LICENSE NUMBER:
BOARD RATING:
MILITARY SCHOOLING:

TRAINING:

*COURSE NAME SCHOOL CONDUCTED BY DATE FROM-TO


BCMT ARCEN ARCEN 28 JANUARY 2010

UADT ARCEN ARCEN 2 MAY 2013

UADT ARCEN ARCEN 22 NOVEMBER 2015

ADT ARCEN ARCEN 24 NOVEMBER 2019

SCHOOLING:

*COURSE NAME SCHOOL CONDUCTED BY DATE FROM-TO

SEMINAR:

*COURSE NAME SCHOOL CONDUCTED BY DATE FROM-TO

WORK HISTORY:

OCCUPATION:

*POSITION:
*POSITION: LGU UTILITY
COMPANY NAME: LGU, EL NIDO, PALAWAN
DATE FROM: 16 JULY 2019 DATE TO:____AT PRESENT______________
AWARDS AND DECORATIONS:

MILITARY AWARD:

*AWARD TYPE *AWARD *ACHIEVEMENT *AUTHORITY


DESCRIPTION

APPRECIATION/ RECOGNITION, PLAQUE OF MERIT, SPECIAL AWARDS:

*AWARD TYPE *AWARD *ACHIEVEMENT *AUTHORITY


DESCRIPTION
CERTIFICATE OF INVALUABLE SPECIAL 42ND AFGR
RECOGNITION SERVICES RECOGNITION
RENDERED AWARD

COMMENDATION:

*GIVEN BY *DATE AWARD

SIGNATURE OVER PRINTED NAME

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