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: MailEmailOffice of Chief AdministratorNew ER Bldg., 4th FloorBicol Medical CenterBMC Road, Concepcion Pequeña, Naga City, 4400bmc.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 * Passport Driver's License SSS ID GSIS ID Postal ID Voter's ID School/Company ID Upload ID * Files must be less than 2 MB.Allowed file types: gif jpg jpeg png. B. REQUESTED INFORMATION Title of Request * Date From/Period (YYYY-MM-DD) * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20182019202020212022202320242025202620272028 Date To (YYYY-MM-DD) Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20182019202020212022202320242025202620272028 Purpose * Message * C. DECLARATIONPrivacy NoticeOnce 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 *