RBI Form A

Download as xlsx, pdf, or txt
Download as xlsx, pdf, or txt
You are on page 1of 2

RBI FORM A

RECORD OF BARANGAY INHABITANTS BY HOUSEHOLD


A. REGION: PSG
B. PROVINCE:
C
O
C. CITY/MUNICIPALITY: D
E
D. BARANGAY: S

E: HOUSEHOLD NO:
NAME (1) ADDRESS (2)
EX SE
NAME OF CIVIL
T. STREET PLACE OF BIRTH DATE OF X CITIZEN OCCUPATI
LAST NAME FIRST NAME MIDDLE NAME SUBDIVISION/ZON STATU SHIP (7)
Age NAME E/SITIO/ PUROK(if (3) BIRTH (4) ON (8)
(1.1) (1.2) (1.3) S (6)
(1.4 (2.2) applicable) (2.3) (5)
)

Prepared by: Certified Correct: Validated by:

JEFFREY V. PANEBIO HON. RITA P. MARAVILLAS


Name of Household Head/Member Barangay Secretary Punong Barangay
(Signature over Printed Name) (Signature over Printed Name) (Signature over Printed Name
RBI Form B
INDIVIDUAL RECORD OF BARANGAY INHABITANT
REGION: IX CITY/MUN: Salug
PROVINCE: Zamboanga del Norte BRGY: Bacong
1. PERSONAL INFORMATION
NAME:
(LAST) (FIRST) (MIDDLE) (EXT)

DATE OF BIRTH / /
MM DD YYYY PLACE OF BIRTH

SEX: MALE CIVIL STATUS: SINGLE WIDOW / ER


FEMALE MARRIED SEPARATED
CITIZENSHIP:
PROFESSION/OCCUPATION:
RESIDENCE ADDRESS:
House No. Street Name

Subdivision Name/Zone/Sitio/Purok

I hereby certify that the above information is true and correct to the best of my knowledge.

Date Accomplished Name/Signature of Person Accomplishing the Form

Attested by: Left Right


Thumbmark Thumbmark

JEFFREY V. PANEBIO
Barangay Secretary

Note: The Household No. shall be filled up by the Barangay Secretary Household Number

You might also like