PERSONAL DATA SHEET - Judicial and Bar Council

23. PRACTICE OF LAW (including the holding of an office which requires admission to the bar as a pre-requisite)a. Number of Years of b. Nature of Current c. If private practitioner, latest MCLE Compliance Certificate No.Practice of Law:Practice:with Compliance Period:24. LITIGATION EXPERIENCEa. Number of Years of Civil Litigation Experience: b. Number of Years of Criminal Practice Experience:c. Number and Nature of Cases Handled in the Past 5Years:d. Number and Nature of Cases Won in the Past 5Years:e. Number and Nature of Cases Lost in the Past 5Years:f. Number of Cases Handled in the Appellate Courts inthe Past 5 Years:g. Significant Cases Handled in the Past 5 Years:Case Title/Docket No. Type of Case CourtDateFiledDateDecidedNames, Current Addresses & Tel. Nos. ofCounsel for the other Parties25. JUDICIAL EXPERIENCEa. Current Caseload: (with cut-off date) b. Average Monthly Output:as of:c. Number and Percentage of Cases Disposed of in thePast 5 Years:d. Number of Decisions Appealed or Pending Appeal:e. Percentage of Affirmances in the Past 5 Years: f. Percentage of Reversals in the Past 5 Years:g. Performance Rating in the past 3 Years:h. Cases Undecided or Unresolved within the Reglementary Period:Have you failed to decide cases or resolve motions within the reglementary period? No Yes If Yes, give particulars.Case Title Docket No. Type of Case Date FiledDate Submittedfor Decision orResolutionDate Extension ofTime was Requested& Granted(continue on separate sheet if necessary)Page 3 of 6

26. TEACHING EXPERIENCESchool Inclusive Period Nature of Appointment Courses Taught27. OTHER CREDENTIALS (Include awards received; special skills; law books or other legal articles written, edited, orpublished with citations, dates and general description of the subject matter; and membership in professional, civic, orother organizations or committees)RECORD OF CASES FILED AGAINST YOU28. FORMAL OR INFORMAL COMPLAINTS FILED AGAINST YOU (Civil, Criminal, or Administrative includingdisbarment and contempt of court)Have you ever been charged with violation of any law, decree, ordinance, administrative issuance, or regulation by anycourt, prosecution office, tribunal, or any other government office, agency or instrumentality in the Philippines or in anyforeign country? No Yes If Yes, give particulars:Case Title/Docket No.Date FiledComplainant’s Name, Address& Tel. No.Type ofComplaintCourtDisposition29. PENDING CASES OR COMPLAINTS AGAINST YOUIs there any pending civil, criminal, or administrative (including disbarment and contempt of court) case or complaintagainst you for violation of any law, decree, ordinance, administrative issuance, or regulation before any court,prosecution office, any other office, agency or instrumentality of the government, or the Integrated Bar of the Philippinesor in any foreign country? No Yes If Yes, give particulars:Case Title/Docket No.Date FiledComplainant’s Name, Address& Tel. No.Type ofComplaintCourtStatusPage 4 of 6

30. DECIDED CASES AGAINST YOUHave you been found liable for, guilty of, or imposed a sanction or penalty for violation of any law, decree, ordinance,administrative issuance, or regulation by any court, tribunal, bar association, disciplinary committee, or any othergovernment office, agency or instrumentality in the Philippines or any foreign country? No Yes If Yes, give particulars:Case Title/Docket No.Date FiledComplainant’s Name, Address& Tel. No.Type ofComplaintCourtDate Decided /Disposition31. TERMINATION OF EMPLOYMENTOTHER MATTERSHave you been retired, dismissed, or forced to resign from employment?Yes NoIf yes, state particulars.32. CANDIDACY FOR ELECTIVE OFFICEHave you been a candidate for any elective office in any election?YesNoIf yes, when and for what position?33. RELATIVES in the Judiciary in the Region where you seek to be appointedName Position Place of Assignment Nature of Employment RelationshipREFERENCES34. Persons not related to you by consanguinity or affinity who have knowledge of your personal or professional background.Name Address Tel. No.Page 5 of 6

AGREEMENTI declare under oath that the answers given above are true and correct to the best of my knowledge and belief. Ibind myself to inform the Judicial and Bar Council (JBC) of any material changes that may arise in the future affecting theinformation contained herein.Likewise, I authorize the JBC and its agents or representatives to verify the truth of any of the above informationor to conduct investigation on my background and qualifications from any and all available sources. In this regard, Iauthorize any government or law enforcement agency and its representatives or agents, as well as private individuals orentities, to release any document, record or information they may have about me that the JBC may request. I agree thatthe information contained herein and public documents submitted by me or gathered by the JBC, except personalinformation such as those under numbers 11 to 16, the addresses and telephone numbers of other persons, shall be open tothe public.Furthermore, I am willing to be nominated for appointment to any of the vacancies which I applied for. If I amnot nominated at all, the JBC is not obliged to disclose the reason. In the event that I decide to withdraw my applicationor decline my nomination, I shall immediately notify the JBC in writing. Should I be appointed to the position I amapplying for, I am committed to assume the duties and functions of the said office.__________________________Signature__________________________DateJURATSUBSCRIBED AND SWORN to before me in the City/Municipality of _______________________, this_____ day of ________________________ 20___, affiant exhibiting to me his/her Community Tax Certificate No.__________________________ issued at _____________________________ on _________________________.Doc. No. _______;Page No. _______;Book No. _______;Series of 20 _____.__________________________Notary PublicPDS-Form-October 2011Page 6 of 6