Republic of the Philippines

Region XII
Barangay Government of ______________________
CITY GOVERNMENT OF COTABATO
Cotabato City

BARANGAY RESIDENTS BIO-PROFILE

CITY :____________________________________
BARANGAY:_______________________________
I – PERSONAL INFORMATION

LAST NAME :__________________________________________________________________________

FIRST NAME : _________________________________________________________________________

MIDDLE NAME : _______________________________________________________________________

SEX :________________________________________________________________________________

CIVIL STATUS :________________________________________________________________________

BIRTH DATE :_________________________________________________________________________

BIRTH PLACE :________________________________________________________________________

HEIGHT :____________________________WEIGHT :______________________BLOOD TYPE:________

CONTACT NUMBER :

TELEPHONE(BARANGAY HALL):_________________TELEPHONE(RESIDENCE)_______________

CELLPHONE :_______________________________E-MAIL ADDRESS:_____________________

RESIDENTIAL ADDRESS:_________________________________________________________________

HIGHEST EDUCATIONAL ATTAINMENT:____________________________________________________

PROFESSION/OCCUPATION:_____________________________________________________________

RELIGION:____________________________________________________________________________

BENEFICIARY

NAME RELATIONSHIP DATE OF BIRTH

_____________________________ ______________________________ ___________________

_____________________________ ______________________________ ___________________

_____________________________ ______________________________ ___________________

I hearby certify that the above information were true and correct to the best of my knowledge.

_________________________________ ________________________________

Date Accomplished Signature over Printed Name