Republic of the Philippines
CITY GOVERNMENT OF BUTUAN
CITY TOURISM AND CULTURAL AFFAIRS DEPARTMENT
Cong. Jose Aquino II Training Center, Brgy. Libertad, Butuan City
MUTYA HONG BUTUAN
Application Form
Disclaimer: Mutya Hong Butuan Committee neither collects nor has it authorized any
person/entity to collect any fee in connection with this application.
PLEASE READ BEFORE FILLING OUT THIS APPLICATION FORM:
In compliance with the provisions of the Data Privacy Act of 2012 (Republic Act No.
10173), you are hereby given notice that:
1. The information and supporting documents that you are about to provide or have
provided will be used by the Mutya Hong Butuan Committee solely for the purpose of
determining and evaluating your fitness and eligibility to join the 2024 Mutya Hong Butuan
Beauty Pageant.
2. This Application Form and all other documents that are required from you will be
stored in City Tourism Office at City Hall, Doongan, Butuan City until the Mutya Hong
Butuan Beauty Pageant Coronation Night.
3. Upon reasonable demand before the Mutya Hong Butuan Beauty Pageant
Coronation Night, you will have the right to access this Application Form and all documents
you have submitted; correct inaccuracies or errors in the information provided; and
suspend, withdraw or order the blocking removal or destruction of any and all information
and documents provided.
4. You may call Mutya Hong Butuan Committee at 09388521916 (Smart) or
09063828299 (Globe), or e-mail to
[email protected] for all concerns related to the
information provided in this application form and all other documents required to be
submitted.
By affixing your signature below, you represent and warrant that:
i. All information that you will provide or have provided are true and correct to the
best of your knowledge, freely and voluntarily given for purposes of allowing Mutya Hong
Butuan Committee to determine your eligibility to join the Pageant;
ii. You likewise categorically and explicitly authorize Mutya Hong Butuan Committee
and affiliates to keep, store, use, access, and process all information that you will provide or
have provided in this Application Form and the documents required to be submitted.
iii. You fully understand and confirm that signing this document means giving your
consent and that you do so freely, knowingly, voluntarily, willingly and under no duress, and
that your application for entry into the Pageant as a prospective candidate will not be
processed or entertained without first affixing your signature below.
Email: [email protected]
Website: http://www.butuan.gov.
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Republic of the Philippines
CITY GOVERNMENT OF BUTUAN
CITY TOURISM AND CULTURAL AFFAIRS DEPARTMENT
Cong. Jose Aquino II Training Center, Brgy. Libertad, Butuan City
_________________________________________________________________ ___________________________________
Applicant’s Signature over Printed Name Date
(Please fill out this Application Form in your own handwriting and submit to Mutya Hong
Butuan Committee.)
PERSONAL INFORMATION
Full Name
Nick Name
Present Address
Permanent Address
Birth Date Age
Place of Birth
Landline No. Mobile No. Email Address
OCCUPATION
Type of Employer & Employer
Position Contact Number
Employment Address
Present
Employment
Previous
Employment
CONTRACT
Contract Description Contracting Party Validity Period
Email: [email protected]
Website: http://www.butuan.gov.
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Republic of the Philippines
CITY GOVERNMENT OF BUTUAN
CITY TOURISM AND CULTURAL AFFAIRS DEPARTMENT
Cong. Jose Aquino II Training Center, Brgy. Libertad, Butuan City
PAGEANT EXPERIENCE
Beauty Contest/Organizer Awards Received Date
EDUCATIONAL ATTAINMENT
Level Name of School Address Year Graduated
Primary
Secondary
College
Graduate Studies
OTHER PERSONAL INFORMATION
Language/Dialect Spoken
Hobbies
Email: [email protected]
Website: http://www.butuan.gov.
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Republic of the Philippines
CITY GOVERNMENT OF BUTUAN
CITY TOURISM AND CULTURAL AFFAIRS DEPARTMENT
Cong. Jose Aquino II Training Center, Brgy. Libertad, Butuan City
Sports
Talents/Skills
Handler
FAMILY BACKGROUND
Family Member Occupation Contact Number
Mother
Father
Guardian (if applicable)
BODY MEASUREMENTS AND INFORMATION
Height Bust
Weight Waist
Hair Color Hips
Eye Color Shoe Size
PERSONAL REFERENCES
Name Address Contact Number
Email: [email protected]
Website: http://www.butuan.gov.
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Republic of the Philippines
CITY GOVERNMENT OF BUTUAN
CITY TOURISM AND CULTURAL AFFAIRS DEPARTMENT
Cong. Jose Aquino II Training Center, Brgy. Libertad, Butuan City
SOCIAL MEDIA HANDLES
Facebook Twitter Instagram
Reason/s for applying/joining Mutya Hong Butuan 2024 Pageant:
Other interesting personal information (if any):
CERTIFICATION AND WARRANTY OF INFORMATION/STATEMENTS
1. I certify that all of the following information/data and/or matters indicated in this
application form and such documents attached hereto are true, and that there are no false
statements, misrepresentations or omissions herein. Any such false statements,
misrepresentations or omissions will be sufficient ground for Mutya Hong Butuan
Committee to disqualify this application, without prejudice to any other legal remedies
Mutya Hong Butuan Committee may be entitled to under the premises.
2. I further certify that:
a. I am 18- 26 years old on the coronation night, and at least 5’4” in height;
b. I am neither married, nor have I ever been married; I have never sought the
annulment of my marriage or the declaration of nullity thereof; I have never been, nor am I
presently, pregnant. I have neither given birth to a child nor am I a parent;
c. I am of good moral character;
d. I have never participated in any bikini open/ shows, bold/burlesque shows, plays,
movies, publications or activities, or such show, play, movie, publication or activity, which,
in the sole opinion and discretion of Mutya Hong Butuan Committee, is inconsistent with my
application to the Pageant, run counter against the social and moral principles upon which
Email: [email protected]
Website: http://www.butuan.gov.
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Republic of the Philippines
CITY GOVERNMENT OF BUTUAN
CITY TOURISM AND CULTURAL AFFAIRS DEPARTMENT
Cong. Jose Aquino II Training Center, Brgy. Libertad, Butuan City
the Pageant is founded, and/or bring disrepute or embarrassment to
Mutya Hong Butuan or any of its sponsors;
e. I have not engaged in prostitution or any such act which can be deemed as
similar or related thereto;
f. I am not a party to any existing contract, which, in the sole opinion and discretion
of Mutya Hong Butuan Committee, shall cause my disqualification as an applicant to, or a
candidate of, the pageant; and
g. I was born with the anatomy of a female and that I have not consented to and/or
underwent any surgical, medical and/or cosmetic procedure to transform myself into a
biological female.
DOCUMENTS TO BE SUBMITTED
Attached with this application form is/are copy(ies) of the following documents, the
original of which I am presenting to the Mutya Hong Butuan Organizers for comparison
and verification:
1. Authenticated copy of Birth Certificate
2. Residence (Cedula)
3. High School or College Diploma
4. Medical Certificate for my Physical health and well-being; and
5. Certificate of Good Moral Character given by my School, Church or Professional
Organization.
6. In addition to the documents listed above, I also submit two (2) photographs, one
close-up and one full body shot in 5R size.
Date received : _________________________
Received by : _________________________
Email: [email protected]
Website: http://www.butuan.gov.
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