Republic of the Philippines

Department of the Interior and Local Government

NATIONAL HEADQUARTERS PHILIPPINE NATIONAL POLICE
Camp Crame, Quezon City

PNP PERSONAL DATA SHEET Badge Nr :

2X2 TIN :
(Without headgear)
Phil Health No:

WARNING!
The correctness of all statement or entire 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, First, Middle 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 19. ETHNIC GRP

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

22. DEPENDENTS
NAME Birth Date Relationship Address

23. HOUSING DATA

( ) Own House and Lot ( ) Rent House ( ) Occupying Gov’t Qtrs

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

___________________________
Signature
 II. APPOINTMENT DATA AND EXPERIENCE/ TIG DATA

EFFECTIVITY DATE OF APPOINTMENT EFFECTIVE DATE OF PROMOTION

OF PREVIOUS RANK BY CSC OF PREVIOUS RANK PER PNP SO/GO

STATUS DATE STATUS DATE AUTHORITY

Temporary _____________ Temporary __________ _________
Permanent _____________ Permanent __________ _________
EFFECTIVITY DATE OF APPOINTMENT EFFECTIVE DATE OF PROMOTION
OF PRESENT RANK BY CSC OF 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 DEFECIENCY :_________________(specify)

( ) TRAINING ( ) Others MONTH/YEAR:_________________

SOURCE OF COMMISSION/ENTRY TO THE PNP

YEAR YEAR
( ) AFP Regular ( ) AFP Reserve ( ) SPO4-PINSP PROM_____ ( ) PMA____
( ) CIS ( ) INP ( ) NAPOLCOM ( ) LATERAL ENTRY _____( ) PNPA___
( ) PNP____
III. EDUCATIONAL BACKGROUND
DEGREE
LEVEL NAME OF SCHOOL LOCATION YEAR COMPLETED/ HONOR
UNITS RECEIVED
ELEMENTARY
SECONDARY
COLLEGE
POST
GRADUATE

IV. POLICE/MILITARY TRAINING CAREER COURSE

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

_______________________
Signature
 V. POLICE/CIVIL SERVICE/NAPOLCOM/PRC ELIGIBILITIES

TITLE OF EXAMINATION 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)

RATING PERIOD RATING RATER

VIII. STATEMENT OF ASSETS AND LIABILITIES, NETWORTH

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

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 CHARGE TYPE OF CHARGE STATE/DISPOSITION

(State whether Administrative or Criminal) (Principal or what) (Exonerated, etc,-Penalty)

_________________
Signature
 XI. DATA ON PREVIOUS RETIREMENT/DISMISSAL/SUSPENSION

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

XII. PHYSICAL AND MEDICAL RECORD

DATE OF LAST MEDICAL EXAM: WHERE TAKEN:

DATE OF LAST DENTAL EXAM: WHERE TAKEN:

DATE OF LAST PN EXAM: WHERE TAKEN:

DATE OF LAST DRUG TEST: WHERE TAKEN:

DATE OF LAST PHYSICAL FITNESS TEST: WHERE TAKEN:

XIII. POLICE/MILITARY MAJOR DESIGNATIONS

(For PCOs as Pltn Ldr, COP, BN/CPS/CPO/PPO/PRO/NSU STAFF, MG CONDR, CD/DP)
POSITION/DESIGNATION UNIT INCLUSIVE DATES

XIV. PROMOTION RECORDS

OLD RANK NEW RANK EFF DATE STATUS AUTHORITY

XV. OTHER COURSES/TRAININGS/SEMINARS (Present Rank)

COURSE TAKEN SCHOOL/LOCATION INCLUSIVE TRAINING CLASSSTANDING/

DATE HOURS HONOR RECEIVED

__________
Signature
 XVI. FIREARMS RECORD

LICENSE NO. KIND MAKE CALIBER AMMO ISSUING UNIT

XVII. AWARDS AND RECOGNITIONS RECEIVED (In Present Rank)

NATURE OF AWARD DATE AWARDED AUTHORITY

INDIVIDUAL UNIT CITATION

NATURE OF AWARD DATE AWARDED AUTHORITY

INDIVIDUAL AND UNIT AWARDS/STREAMERS

NATURE OF AWARD DATE AWARDED AUTHORITY

LETTERS OF COMMENDATIONS/PLAQUES/CERTIFICATES OF APPRECIATION,

COMMENDATIONS/MERITS (Not yet converted to medals)
NATURE OF AWARD DATE AWARDED AUTHORITY

ACADEMIC AWARDS
NATURE OF AWARD DATE AWARDED AUTHORITY

________________
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 _________

2018 at __________________________________________________ Philippines.

____________________________
Administering Officer