Page 99 - Area X - D

RSONAL DATA SHEF^*
WARNING: Any misrepresentation made in die Personal Data Sheet and the Work Experience Sheet shall cause die filing of administrative/criminal case/a against die person
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPUSHING THEPDS FORM
Print legibly. Tick appropriate bones ([~D and use separate sheet if necessary Indicate N'A if not applicabl^ DO NOT ABBREVIATE[^t^ iDNo] (Do not (ill uo- For CSC use only)

2. SURNAME
FIRSTNAME [NAME EXTENSION (JR., SR| N/A
MIDDLE NAME DUMAYAHON
3. DATE OF SIRTH
(mnVdd/yyyy) 0 Filipino D Dual Citizenship
0 by birth 0 by naturalization
If holder of duN citizenship, Pis. Indicate country:
? Male 0 Female pleas* indicate the details.
? Single E aed 17, RESIDENTIAL-ADDRESS
D widowed 0 Separated
0 Otfter/s: Nayon
Sub^^^rSCTvWflqa Barangay

IB. PERMANENT ADDRESS

11. PAG-IBIGIDNO. Ifugao
Province'"'"
12. PHILHEALTH NO.
19. TELEPHONE NO,
0955-3650-246
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) N/A

2^ SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF SIRTH (mm/dd/yyyy)
[NAME EXTE
FIRST NAME
LYNETTE L. WARTENWEILER
MIDDLE NAME
XCUPATION
MARINELE L PINGOL
EMPLOYER^^^USINESSNAME BEVERLY L. TEGUI-II
BUSINESS ADDRESS
TELEPHONE NO.
24. FATHERS-SURNAME LUNAG (DECEASED)
FIRSTNAME '. ' " INAMEEXTENS
MIDDLE-NAME
25. MOTHER'S MAIDEN NAME

FIRSTNAME
MIDDLE NAME (Continue on separate sheet if necessary)
)g^^^^mS^^
NAME OF SCHOOL PERIOD OF ATTSCANCE HIGHEST LEVEL/
(Write in (OP) (Write in full]
From
NAGACADAN ELEU. SCHOOL Elementary education ,
ST. JOSEPH'S SCHOOL High school! !
VOCATIONAL/ ",
TRADE COURSE I

ST. MARY'S UNIVERSITY/IFUGAO STATE
GRADUATE STUDIES MASTER IN PUBLIC ADMINISTRATION 27 EARNED
UNIVERSITY UNITS
( ontinue on separate sheet if necessary)
DATE
CS FORM 2f 2 fs^M 2011). Pag* J d 4