2” x 2”
Picture
Name of Corporation
PERSONAL INFORMATION SHEET
Name
Position
I hereby certify that all information contained in this document and its supporting
schedules are true and correct of my own knowledge and belief.
Date
Signature of Affiant
REPUBLIC OF THE PHILIPPINES)
IN THE CITY OF ) S.S.
SUBSCRIBED AND SWORN TO before me this ____ day of ______________,
_____ the above affiant exhibiting to me his/her Tax Identification Number ___________
issued at ____________________ on ____________________.
NOTARY PUBLIC
Doc. No. __________
Page No. __________
Book No. __________
Series of __________
Page 1 of 4
I. PERSONAL
1. Name
2. Citizenship
3. Date of Birth
4. Place of Birth
5. Civil Status
6. Residence Address & Telephone Number
a) Present
b) Residence for the past 15 years
7. Business Address & Telephone Number
8. For Alien only
a) ACR Number: ________________ Date Issued: ____________
b) Passport Number ________________ Date Issued: ____________
II. EDUCATION AND TRAINING
9. College or University Education only or highest educational attainment; if not a degree holder.*
Degree/Course School Last Attended Year Graduated
10. Training in financial management and other related fields.*
Nature/Title Conducted by Year Taken
III. WORK EXPERIENCE
11. Account all time for the past ten (10) years. Include full and part-time work, self-employment,
government service, unemployment and full-time education.*
Duration
Name of Office Position From To
_____________________________
* Attach additional sheet if needed
Page 2 of 4
IV. FAMILY RELATION
INFORMATION REGARDING DOSRI**
12. Name of Spouse: __________________________
13. First Degree (Relatives of legal age only) by Consanguinity: Parents and Children*
Name (Surname, Given, Middle) Others Name Used Relationship
14. First Degree (Relatives of legal age only – by Affinity: Parents-in-law and Children-in-law*
Name (Surname, Given, Middle) Others Name Used Relationship
15. Relatives by legal adoption*
Name (Surname, Given, Middle) Others Name Used Relationship
16. Is your spouse an officer/director of corporation, association or firms other than this institution?
□ Yes □ No
If yes, please state:
___________________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
17. Schedule of Business Establishments where the Directors/Officer, Spouse and First Degree
Relatives have Equity Interest at year end. _______________________________.
Name of Pertinent
Name of Corporation/ Percent Holding to
Stockholder/ Member,
Association/Firm Total Equity
General Partner
____________________________________________________
* Attach additional sheet if needed
Page 3 of 4
**Refers to Directors, Officers, Stockholders and Related Interest
V. DISCIPLINARY HISTORY
18. Have you ever been convicted, judicially or administratively of an offense declared insolvent,
spendthrift or incapacitated to contract?
□ Yes □ No
Particulars/Nature of Offense Court of Jurisdiction Date of Information Filed
If yes, please state:
19. Have you ever been involved in any criminal, civil or bank cases in any courts of justice,
administrative agencies, quasi-judicial bodies, or any tribunal?
□ Yes □ No
If yes, please state:
Particulars/Nature of Offense Court of Jurisdiction Date of Information Filed
Page 4 of 4
