Republic of the Philippines DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT BUREAU OF JAIL MANAGEMENT AND PENOLOGY 1.44 BIMP Building, Mindanao Avenue, Project 8, Qeuzon City APPLICATION FOR BJMP IDENTIFICATION CARD 41. Ono (1) 2x2 colored ID Picture in GOA Uniform wio headyea") 2 Ifeeprad,stlach ol Identification Cars 4, Xerox copy of 0 Identfieatin Carel (hack to back) 3. Auherticated Xerox copy of Latest Paysip 5 Most atach Afigent of Loss Rank First Name Last Name Contact No. Permanent Home Address, Region Assigned Date of Binh “Tax Identification Number Blood Type ‘Account Number Badge Number cight (kg) Height (em) Color of Eyes | Color of Hair Complexion Tn case of Emergency. Please Notify Contact Namber Relationship HOME ADDRESS Signature Date of Application: EE