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  • BOIS Revised 2023

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    Jet Diay Ko
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    This document is an annex form from the Department of the Interior and Local Government (DILG) that collects personal and political information from barangay officials. It requires officials to provide details like their position, term of office, personal information like name, birthdate, address, education level, other occupations, and beneficiaries. It states that by signing, the official consents to DILG processing their personal information as required to carry out its mandate under the Philippine Data Privacy Act of 2012.

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    BOIS-Revised-2023

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    This document is an annex form from the Department of the Interior and Local Government (DILG) that collects personal and political information from barangay officials. It requires officials to provide details like their position, term of office, personal information like name, birthdate, address, education level, other occupations, and beneficiaries. It states that by signing, the official consents to DILG processing their personal information as required to carry out its mandate under the Philippine Data Privacy Act of 2012.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    31 views2 pages

    BOIS Revised 2023

    Uploaded by

    Jet Diay Ko
    This document is an annex form from the Department of the Interior and Local Government (DILG) that collects personal and political information from barangay officials. It requires officials to provide details like their position, term of office, personal information like name, birthdate, address, education level, other occupations, and beneficiaries. It states that by signing, the official consents to DILG processing their personal information as required to carry out its mandate under the Philippine Data Privacy Act of 2012.

    Copyright:

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

    BOIS Revised 2023

    ANNEX “A”

    Passport Size
    Republic of the Philippines
    Photo
    Department of the Interior and Local Government

    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* : IX CITY/MUNICIPALITY* : DINAS

    PROVINCE* : ZAMBOANGA DEL SUR BARANGAY* :

    ELECTIVE AND APPOINTIVE POSITION


    (Instruction: Check the acquired position)

    DATE OF ASSUMPTION TO OFFICE/APPOINTMENT * : NOVEMBER 20, 2023 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.

    JUAN DELA CRUZ


    (Signature over Printed Name) (Date Accomplished)
    Verified and validated by:
    JEHANNE LORELEI A. RODRIGO
    LGOO VI / MLGOO Date

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