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OSCA Form No. 1 SCID Registration

This document is a registration form for a senior citizen ID from the City Mayor's Office of Davao City, Philippines. It requests information such as the applicant's name, date of birth, address, emergency contact, and status as a senior citizen association member, retiree, or government pensioner. It outlines the requirements for application as proof of age like a birth certificate, proof of residency like a barangay certification, and 2 ID photos. It has spaces for the applicant and local officials to sign off on verifying the information and releasing the senior citizen ID.

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Kimberly Legion
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Download as PDF, TXT or read online on Scribd
1K views

OSCA Form No. 1 SCID Registration

This document is a registration form for a senior citizen ID from the City Mayor's Office of Davao City, Philippines. It requests information such as the applicant's name, date of birth, address, emergency contact, and status as a senior citizen association member, retiree, or government pensioner. It outlines the requirements for application as proof of age like a birth certificate, proof of residency like a barangay certification, and 2 ID photos. It has spaces for the applicant and local officials to sign off on verifying the information and releasing the senior citizen ID.

Uploaded by

Kimberly Legion
Copyright
© © All Rights Reserved
Available Formats
Download as PDF, TXT or read online on Scribd
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OSCA FORM NO. 1 CMO.OSCA.F.001 REV.

00 16 MAY 2022
Series of 2022

REPUBLIC OF THE PHILIPPINES


CITY MAYOR’S OFFICE
OFFICE FOR SENIOR CITIZENS AFFAIRS Requirements:
MAIN OFFICE 1. Proof of Age: Any of the ff:
Agton Street, Toril, Davao City, Davao Del Sur Birth/Baptismal Certificate or Gov’t issued ID
(OSCA bldg.) Tel. No.: 272 4029 w/Birthdate/Mailing address
(CSWDO bldg.) Tel. No.: 241-1000 Loc. 394-395 2. Proof of Residency: Barangay Certification
w/inclusion of Date of Birth.
CITY OF DAVAO 3. 2 PCS 1”x1” ID Picture (w/Collar)
SENIOR CITIZEN ID REGISTRATION FORM For Replacement:
Revised 2022 Barangay Certification (If applicable)

FOR ONLINE APPLICATION VIA EMAIL ADD.:


Control #: _________________ (District I) [email protected]
Date: _____________________ (District II) [email protected]
(District III) [email protected]

Fill in all the required information. Do not leave an item blank. If item is not applicable, indicate "N/A".
NAME:

Given Name Middle Name Surname


mm-dd-yyyy
Date of Birth: Age: Gender: Civil Status:

Place of Birth: Contact #:

Complete Address:

Barangay: District:

In Case of Emergency Please Notify: Senior Citizen is a social pensioner


Senior Citizen is retiree
Name: __________________________________ City Government annual financial assistance
beneficiary (1,500)
Contact No.: _____________________________ Fully vaccinated
Validated (SafeDavaoQR)
Relationship: ____________________________
Name of Senior Citizen Assn.:________________________
Name of Chapter Pres.: ____________________________

Applicant Approved for Release Released by:


Signature over printed Name LUIS R. MORAN Signature Over printed Name
OSCA HEAD
(This part is to be filled up by the OSCA)
New Rep
Date Verified: PICTURE ID
Claimant’s Signature over Printed Name Verified by: 1”x1”
Contact No.: Name
Validator:
Date: ID NO.:
Name

I hereby authorize the Office for Senior Citizens’ Affairs (OSCA) to collect and process the above information for the purpose of Senior
Citizens’ ID Application. I understand that my personal information is protected by R.A. 10173, Data Privacy Act of 2012.

______________________________________________________
Name and Signature of Senior Citizen / Authorized Representative

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