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.: DATE ACCOMPLISHED:

NAME (1) ADDRESS (2)

NAME OF CIVIL CITIZEN-
PLACE OF BIRTH DATE OF SEX OCCUPATION
SUBDIVISION/ZONE/ STATUS SHIP
LAST NAME FIRST NAME MIDDLE NAME EXT NO. STREET NAME BIRTH
SITIO/PUROK (if (3) (5) (8)
(1.1) (1.2) (1.3) (1.4) (2.1) (2.2) (4) (5) (7)
applicable)
(2.3)

Prepared by: Certified Correct: Validated by:

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 CITY/MUN

PROVINCE BGY

I. PERSONAL INFORMATION

NAME:
(Last) (First) (Middle) (Ext)

DATE OF BIRTH PLACE OF BIRTH

MM DD YYYY ____

□□

□□
SEX: MALE CIVIL STATUS; SINGLE WIDOW/ER
□
n 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
Barangay Secretary

Note: The Household No. shall be filled up by the Barangay Secretary. Household Number
KW FORMC
MONITORING REPORT FORM
as of

A. REGION:
PSG
B. PROVINCE: CODES
C. CITY/WIUNICIPALITY:

TOTAL NO, OF BARANGAYS:

NO. OF BARANGAYS with RBI:

Barangays with RBI Barangays with RBI

Prepared by: Submitted by:

C/MLGOO Province/City Director

(Signature over Printed Name) (Signature over Printed Name)

Date Accomplished: