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    Kent Charles M. Notario
    This document is an information sheet for barangay officials for the 2023-2025 term. It collects personal details like name, position, contact information, education level, and beneficiaries. Officials must fill this out legibly in capital letters. They also consent to the DILG processing their personal data according to the Data Privacy Act. The form is then verified by community development or local government operations officers.

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    © All Rights Reserved
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    Updated Form

    Uploaded by

    Kent Charles M. Notario
    217 views2 pages
    This document is an information sheet for barangay officials for the 2023-2025 term. It collects personal details like name, position, contact information, education level, and beneficiaries. Officials must fill this out legibly in capital letters. They also consent to the DILG processing their personal data according to the Data Privacy Act. The form is then verified by community development or local government operations officers.

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    This document is an information sheet for barangay officials for the 2023-2025 term. It collects personal details like name, position, contact information, education level, and beneficiaries. Officials must fill this out legibly in capital letters. They also consent to the DILG processing their personal data according to the Data Privacy Act. The form is then verified by community development or local government operations officers.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    217 views2 pages

    Updated Form

    Uploaded by

    Kent Charles M. Notario
    This document is an information sheet for barangay officials for the 2023-2025 term. It collects personal details like name, position, contact information, education level, and beneficiaries. Officials must fill this out legibly in capital letters. They also consent to the DILG processing their personal data according to the Data Privacy Act. The form is then verified by community development or local government operations officers.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 2

    BOIS Revised 2023

    ANNEX “A”

    Republic of the Philippines Passport Size


    Department of the Interior and Local Government Photo

    BARANGAY OFFICIAL’S INFORMATION SHEET


    2023-2025 Term of Office

    NOTE: PLEASE ACCOMPLISH THIS FORM AND WRITE LEGIBLY ALL THE INFORMATION REQUIRED IN CAPITAL LETTERS.

    REGION* : CITY/MUNICIPALITY* :

    PROVINCE* : BARANGAY* :

    ELECTIVE AND APPOINTIVE POSITION


    (Instruction: Check the acquired position)

    DATE OF ASSUMPTION TO OFFICE/APPOINTMENT * : _____________________________ DATE OF ELECTION: October 30, 2023

    Punong Barangay Barangay Treasurer BADAC Cluster Leader


    Sangguniang Barangay Member Barangay Secretary Barangay Health Worker
    Encircle Rank (1, 2, 3, 4, 5, 6, 7) SK Treasurer Accredited/Registered by the Local Health Board
    SK Chairperson SK Secretary Appointed by the Barangay (Barangay Health
    Aide/Health Care Assistant)
    SK Member (Encircle Rank 1, 2, 3, 4, 5, 6, 7) Barangay Nutrition Scholar
    IPMR Barangay Tanod
    Day Care Worker
    TERM IN THE PRESENT POSITION: Accredited per ECCD Council Resolution No. 15-03
    1st 2nd 3rd Appointive/Replacement dated Sept. 10, 2015
    Lupon Member
    VAW Desk Officer
    If related with the Appointing Authority, please indicate the
    degree of consanguinity/affinity: _______________________

    PERSONAL AND POLITICAL INFORMATION


    - - -
    (PhilSys Card No.)

    (Last Name) * (First Name) * (Suffix e.g. Jr., II, III) (Middle Name) *

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

    (Residence Address) * (Contact Number) * (Official E-mail Address)

    (Barangay Hall Address) * (Barangay Hall Contact Number) * (Barangay E-mail Address)

    HIGHEST EDUCATIONAL ATTAINMENT*: ELEMENTARY HIGH SCHOOL COLLEGE POST GRAD VOCATIONAL

    Graduate ________________________ Under Graduate


    (Course)
    OTHER OCCUPATION,
    IF ANY: HONORARIUM AS BARANGAY OFFICIAL*:
    Private Government
    BENEFICIARIES*: (for Punong Barangay, Sangguniang Barangay Member, SK Chairperson, IPMR, Barangay Secretary, and Barangay Treasurer only)

    NAME DATE OF BIRTH RELATIONSHIP


    (Last Name, First Name, Middle Initial) (mm/dd/yyyy)
    1.

    2.

    3.

    4.

    5.
    (Please use additional sheet if necessary)

    I hereby certify that the above information are true and correct to the best of my knowledge. I understand that for the DILG to carry out its
    mandate they must necessarily process my personal information. Therefore, I grant my consent and recognize the authority of the DILG to
    process my personal information, pursuant to the Philippine Data Privacy Act of 2012.
    (Signature over Printed Name) (Date Accomplished)
    Verified and validated by:

    CD/CLGOO/MLGOO Date
    (Signature over Printed Name)

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