b. Have you resigned from the government service during the three (3)- month period before the last election to promote/actively campaign for a national or local candidate? Have you acquired the status of an immigrant or permanent resident of another country? Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA 7277); and (c) Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items: a. b . c. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee) I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I authorize the agency head/authorized representative to verify/validate the contents stated herein. I agree that any misrepresentation made in this document and its attachments shall cause the filing of administrative/criminal case/s against me. Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.) PLEASE INDICATE ID Number and Date of Issuance ID picture taken within the last 6 months 3.5 cm. X 4.5 cm (passport size) With full and handwritten name tag and signature over printed name Computer generated or photocopied picture is not acceptable YES YES YES NO YES NO YES NO YES NO YES NO YES YES YES NO NO NO YES NO YES NO
AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as in Person Administering Oath CS FORM 212 (Revised 2017), Page 4 o
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- Summer '18
- Sir Lau
- Family name, surname, Jr.