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2014-02-008 Rev 0 Accreditation of School Representatives

BI form for school representatives accreditation

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BI ACCREDITATION ID APPLICATION FORM
FOR SCHOOL REPRESENTATIVES
Attach your 2x2 colored photograph
with white background using
permanent glue in the
photograph box.
The photograph must be taken
within the last three (3) months
from the date of application.
A scanned photograph is not
allowed. A photograph of the
applicant wearing eyewear (i.e.
sunglasses, colored contact lenses,
etc.) or headwear is not acceptable.

REMINDERS:

1. Accomplish this form by writing as legibly & comprehensively as possible.
2. Check the corresponding box of your answer, if applicable.
3. Attach 2 pcs. of your latest 2x2 inches colored photograph with white
background. Scanned photograph is not allowed. A photograph of the applicant
wearing eyewear (i.e. sunglasses, colored contact lenses, etc.) or headwear is
not acceptable.
4. Please comply with the requirements as provided in BI Form 2014-02-007 Rev 0
to avoid delay in issuing your accreditation.
(INFORMATION PROVIDED WILL BE THE BASIS FOR ID PRINTING.)

RECEIPT NUMBER
I. APPLICANT’S PERSONAL INFORMATION
Last Name
First/Given Name
Middle Name
Other Name(s)/Alias(es)
1
2
Date of Birth [DD-MMM-YYYY e.g. 01 JAN 1990]

Gender
M

Height [cm]

Civil Status
F

Weight [kg]

Single

Married

Annulled

Separated

Widowed

Divorced

Citizenship/Nationality
School Employee Number
Residential Address in the Philippines
House/Unit No., Street, Subdivision/Village

Contact Number(s) in the Philippines
Landline

Barangay, Municipality/City

Mobile

Province, Zip Code

Email Address

II. EMPLOYMENT
Designation
Name of Accredited School

School Address
Room No., Floor No., Building, Street

Contact Number(s) of the School
Landline Number

Barangay, Municipality/City

Mobile Number

Province, Zip Code

Facsimile Number

Email Address
III. Have you ever been issued a Ban Order/Cancellation Order in violation of BI Accreditation guidelines or regulations?
YES

NO

If YES, give details: _________________________________________________________________________________________________________
[Violation]
[Date of Order]
[Ban/Cancellation Order Number]
Was your Ban Order lifted? Give details: ________________________________________________________________________________________
[Date of Order]
[Lifting Ban Order Number]
I declare that this BI Accreditation Application Form has been
accomplished by me, and is true, correct and complete pursuant to
the provisions of pertinent laws, rules and regulations of the Republic
of the Philippines.

To be filled out by Authorized BI Personnel only
Remarks:

I also authorized the agency head/authorized representative to
verify/validate the contents stated herein. I trust that information
shall remain confidential.
_________________________________________

Accreditation ID Number

Applicant’s Signature over Printed Name

_________________________________________
Date [DD-MMM-YYYY e.g. 01 JAN 1990]
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