Freedom of Information Request Form

You are required to supply name and address for correspondence, include two (2) scanned copy/photocopy of government-issued ID as a proof of identification.
Additional contact details will help us deal with your application and correspond with you in the manner you prefer.
Please fill up this online form with the relevant details and press the submit when done or you may download, print and send the FOI form via:

Mail	Email
Office of Chief Administrator New ER Bldg., 4th Floor Bicol Medical Center BMC Road, Concepcion Pequeña, Naga City, 4400	bmc.cao2020@gmail.com

A. REQUESTING PARTY

Given Name/s (including M.I.) *

Surname *

Complete Address (Apt/House Number, Street, City/Municipality, Province) *

Landline/Fax

Mobile Number

Email Address

Mode of Communication *

Landline

Mobile

Email

Postal Address

If your request is successful, we will be sending the documents to you in this manner.

Mode of Reply *

Postal Address

Email

Pick-Up to Agency

ID Provided *

B. REQUESTED INFORMATION

Title of Request *

Date From/Period (YYYY-MM-DD) *

Month

Day

Year

Date To (YYYY-MM-DD)

Month

Day

Year

Purpose *

Message *

C. DECLARATION

Privacy Notice

Once deemed valid, your information from your application will be used by Bicol Medical Center to deal with your request as set out in the Freedom of Information Executive Order No. 2.

I declare that:
- The information provided in the form is complete and correct
- I read the Privacy Notice;
- I have presented at least one (1) government-issued ID to establish proof of my identity

Terms and Conditions *

I understand that it is an offense to give misleading information about my identity and may result to refusal of my request.

Tracking Number *

Main Menu

Auxiliary Menu