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Personal Information

First Name*

Middle Name

Last Name*

Extension Name

Birthdate*

Birth Place*

Gender*

Civil Status*

Highest Educational Attainment

Educational Status

Profession / Occupation:

PhilSys Number.

Contact Details

Email Address

Mobile Number.*

Telephone Number.

Region *

Province *

City / Municipality *

Barangay *

House / Block / Lot no.

Street

Subdivision/Village:

Zip Code: (Optional)

Identity Information

Blood Type

Weight (Kilograms)

Height (Feet)

Complexion

Citizenship*

Resident Voter:
YES
NO

Not a resident voter:
YES
NO

Barangay where you vote:

Ethnicity*

Religion

Position:

Mother's Maiden Name

Do you have pet?

Type of Pet

Sectorial Information

Previous Residence

Length of Stay

Reason's For Leaving (Previous Residence)

Date of Transfer

Reason's for transfering in this barangay

Duration of stay in the current barangay

Intention to return to previous residence
YES NO

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I hereby certify that the above information are true and correct to the best of my knowledge. I understand that for the Barangay to carry out its mandate pursuant to Section 394 (d)(6) of the Local Government Code of 1991, they must necessarily process my personal information, subject to the provisions of the Data Privacy Act of 2012. Therefore, I grant my consent that my data will be stored in the LGUSS-BIMS which is a highly secured tool that is being used by the barangay.

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Personal Information

Contact Details

Identity Information

Sectorial Information

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