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# Household ID # Spouse
Name of Grantee M F Attended?
(Yes/No)
IP Affiliation Signature
NAME M F
BACYARAN
Time Ended:
# Household ID # Spouse
Name of Grantee M F Attended?
(Yes/No)
1
2
3
4
5
Total
IP Affiliation Signature
NAME M F
Noted by:
LEIDA S. ROCABO
SWO III
Remarks / Reasons for Not
Attending (Code)