CS FORM 212 (Revised 2005)
PERSONAL DATA SHEET
PDS as of
1. CS ID No.
(to be filled up by CSC)
I. PERSONAL INFORMATION
2. SURNAME
FIRST NAME
3. NAME EXTENSION (e.g. Jr., Sr.)
MIDDLE NAME
16. RESIDENTIAL ADDRESS
DATE OF BIRTH (mm/dd/yyyy)
4.
PLACE OF BIRTH (Town/City
5.
and Province
6. SEX (MALE/FEMALE)
7.
CIVIL STATUS (Single,
ZIP CODE
Married, Widowed,
Separated, Annuled, others
17. TELEPHONE NO.
pls specify.
18. PERMANENT ADDRESS
8. CITIZENSHIP
9. HEIGHT (m)
ZIP CODE
10. WEIGHT (kg)
11. BLOOD TYPE
19. TELEPHONE NO.
12. GSIS ID NO.
20. E-MAIL ADDRESS (if any)
13. PAG-IBIG ID NO.
21. CELLPHONE NO. (if any)
14. PHILHEALTH NO.
22. AGENCY EMPLOYEE NO.
15. SSS NO.
23. TIN
II. FAMILY BACKGROUND
25. NAME OF CHILD (Write full name and list all)
DATE OF BIRTH (mm/dd/yyyy)
24. SPOUSE'S SURNAME
FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUS. NAME
BUSINESS ADDRESS
TELEPHONE NO.
(Continue on separate sheet if necessary)
FATHER'S SURNAME
26.
FIRST NAME
MIDDLE NAME
27.
MOTHER'S MAIDEN NAME
SURNAME
FIRST NAME
MIDDLE NAME
(Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
INCLUSIVE DATES OF
HIGHEST GRADE/
28.
DATE
SCHOLARSHIP/
ATTENDANCE
NAME OF SCHOOL
DEGREE COURSE
LEVEL/
LEVEL
GRADUATED
ACADEMIC HONORS
(Write in full)
(Write in full)
UNITS EARNED
(if graduated)
RECEIVED
From
To
(if not graduated)
ELEMENTARY
SECONDARY
VOCATIONAL /
TRADE COURSE
COLLEGE
GRADUATE STUDIES
(Continue on separate sheet if necessary)
NEDA PDS Form Page 1 of 4