PDS-ODPRM FORM 96-1

Republic of the Philippines

Department of the Interior and Local Government
NATIONAL POLICE COMMISSION
NATIONAL HEADQUARTERS, PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City

Badge No :
TIN :
POLICE PERSONAL FILE Phil Health No.

WARNING !
The correctness of all statements or entries made herein is subject to verification and any deliberate omission or
distortion of information may give sufficient cause for investigation.
Date Accomplished: ___________________________

I. GENERAL INFORMATION
1. NAME (Last Name, First Name, Middle Name, Qualifier)

2. RANK 3. UNIT / STATION -- NSU / PRO / NHQ

4. HOME ADDRESS (House No./Street//Mun./City/Province

5. PLACE OF BIRTH 6. DATE OF BIRTH

7. SEX 8. CIVIL STATUS 9. RELIGION

10. COLOR OF HAIR 11. COLOR OF EYES 12. HEIGHT (cm) 13. WEIGHT (kg)

14. BLOOD TYPE 15. BUILD 16. COMPLEXION

17. LANGUAGES 18. IDENTIFYING MARKS 19. ETHNIC GROUP

20. NAME OF SPOUSE OR NEAREST KIN/ADDRESS 21. OCCUPATION

22. DEPENDENTS
NAME DATE OF BIRTH RELATIONSHIP ADDRESS

23. HOUSING DATA

 Own House and Lot  Rent House  Occupying Govt Qtrs

 Own House Only  Rent Room  Others (Specify)

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Signature
II. APPOINTMENT DATA AND EXPERIENCE / TIG DATA
EFFECTIVE DATE OF APPOINTMENT OF EFFECTIVE DATE OF PROMOTION OF
PREVIOUS RANK BY CSC PREVIOUS RANK PER PNP SO / GO
STATUS DATE STATUS DATE AUTHORITY
TEMPORARY ___________ TEMPORARY _______________________
PERMANENT PERMANENT

EFFECTIVE DATE OF APPOINTMENT OF EFFECTIVE DATE OF PROMOTION OF

PRESENT RANK BY CSC PRESENT RANK PER PNP SO / GO
STATUS DATE STATUS DATE AUTHORITY
TEMPORARY TEMPORARY
PERMANENT PERMANENT

IF PRESENT RANK PASSED DATE SATISFIED THE DEFICIENCY:

TEMPORARY, STATE REASON

 ELIGIBILITY  TIG DEFICIENCY: _____ ___________ (specify)

MONTH/YEAR: __________________
 TRAINING  Others _______

SOURCE OF COMMISSION/ENTRY TO THE PNP

YEAR YEAR
 AFP Regular  AFP Reserve  SPO4 - PINSP PROM _______  PMA _____
 CIS  INP  NAPOLCOM  LATERAL ENTRY CS  PNPA _

III. EDUCATIONAL BACKGROUND

DEGREE
HONORS
LEVEL NAME OF SCHOOL LOCATION YEAR COMPLETED/
RECEIVED
UNITS

ELEMENTARY

SECONDARY

COLLEGE

IV. POLICE/MILITARY TRAINING CAREER COURSE

CLASS
TRAINING STANDING /
COURSE TAKEN SCHOOL / LOCATION INCLUSIVE DATE
HOURS HONORS
RECEIVED

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Signature
V. POLICE/CIVIL SERVICE/NAPOLCOM/PRC ELIGIBILITIES
TITLE OF EXAM DATE TAKEN WHERE TAKEN RATING OBTAINED

VI. PERFORMANCE EVALUATION RATING (Immediately preceding two (2) semesters)

RATING PERIOD RATING RATER

VII. PHYSICAL FITNESS TEST RATING (Immediately preceding two (2) semesters)
FITNESS PERIOD RATING RATER

VIII. STATEMENT OF ASSETS AND LIABILITIES, NETWORTH

(Immediately preceding three (3) Fiscal Years)
FISCAL YEAR TOTAL ASSETS TOTAL LIABILITIES NET WORTH

IX. INDIVIDUAL INCOME TAX RECORDS (Immediately preceding three (3) Fiscal Years)
FISCAL YEAR GROSS INCOME TAXABLE INCOME INCOME TAX PAID

X. OFFENSE DATA
OFFENSE COMMITTED AS CHARGED TYPE OF CHARGED STATUS / DISPOSITION
(State whether Administrative or Criminal) (Principal or What) (Exonerated, etc., - Penalty)

XI. DATA ON PREVIOUS RETIREMENT/DISMISSAL/SUSPENSION

Have you ever been retired, dismissed, forced to resign or suspended from any employment for reasons other than lack
of funds? NO
Have you ever been a candidate in a national/ local election (including barangay election?
POSITION PLACE DATE

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Signature
XII. PHYSICAL AND MEDICAL RECORD
DATE OF LAST PHY/MEDICAL EXAM WHERE TAKEN
DATE OF LAST DENTAL EXAM WHERE TAKEN
DATE OF LAST NP EXAMINATION WHERE TAKEN
DATE OF LAST DRUG TEST WHERE TAKEN
DATE OF LAST PHYS FITNESS TEST WHERE TAKEN

XIII. POLICE/MILITARY MAJOR DESIGNATIONS

(for PCOs: as Pltn ldr, COP, BN/CPS/CPO/PPO/PRO/NSU STAFF, MG COMDR, CD/PD)
POSITON / DESIGNATION UNIT INCLUSIVE DATES

XIV. PROMOTION RECORDS

OLD RANK NEW RANK EFF DATE PROM STATUS AUTHORITY

XV. OTHER COURSES/TRAININGS/SEMINARS (IN PRESENT RANK)

CLASS
TRNG STANDING
COURSE TAKEN SCHOOL / LOCATION INCLUSIVE DATE
HOURS / HONORS
RECEIVED

_______________________________
Signature

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Signature
XVI. FIREARMS RECORD

LICENSE NO. KIND MAKE CALIBER AMMO ISSUING UNIT

XVII. AWARDS AND RECOGNITIONS RECEIVED (IN PRESENT RANK)

INDIVIDUAL MEDALS/RIBBONS
NATURE OF AWARD DATE AWARDED AUTHORITY

INDIVIDUAL AND UNIT CITATION BADGE

INDIVIDUAL AND UNIT AWARDS/STREAMERS

LETTERS OF COMMENDATIONS / PLAQUES / CERTIFICATES OF APPRECIATIONS,

COMMENDATIONS/MERITS (NOT YET CONVERTED TO MEDALS)

ACADEMIC AWARDS
NATURE OF AWARD DATE INSTITUTION

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Signature
XVIII. CERTIFICATION

THIS IS TO CERTIFY that the answers given above are true and correct to the best of my knowledge and belief.

I COMMIT MYSELF TO BE LIABLE for perjury and/or dishonesty as result of any false, misrepresentation or
omission in this Personal Data Sheet.

(signature over printed name)

Community Tax Certificate No:

Issued on:
Issued at:

LEFT RIGHT
THUMBMARK

SUBSCRIBED AND SWORN TO before me this ___ day of _____________ 2007 at

__________________________________, Philippines.

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Signature