PART 1.

Survey of Structures That Maybe Damaged

Area/ Zone:________________ Date (s) Survey: _________________

Surveyor:______________________

Structures* That Maybe Damaged (No occupants)

Types Location Time started & finished
1. Water well

2. Fishpond

3.
4.

5.

*Note: Should be reflected in the spot map.

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 PART II. Socio-Economic Survey of Project-Affected Persons in Zones_____ in Barangay Ingore,
District of Lapaz, Iloilo City
A Joint Project of the Barangay Council and Homeless People’s Federation
of the Philippines-Western Visayas

Lot/Tag Number (Only for structures with occupants): 2017-________ Area/ Zone:_________

Date (s) Survey: __________________________________ Time started & finished: ______________

Enumerator:______________________________________

I. Basic Information
1. Name of Respondent: __________________________________________ 2. Length of stay in the brgy:______

3. Position in the family:______________________________ 4. Age as of last birthday:_________

5. Sex: ___ Male ___ Female

6. Civil Status: ___ a. Never married ____b. Separated ___c. Legally Married ___d. Widowed

7. Current Address (House number): ________________________

8. Length of stay in the house: ___________

II. Household Information

1. Total No. of Households in the Structure:______ (maids, borders, relatives not included)

Total no. of HH members & Description:

Names Relation to Age Sex Highest Educational Sources of

Interviewe Attainment Monthly
e (Indicate Income*
Household (Write letters/
Head) only)

*Sources of income every month:

a. Salary b.contract c. pension d. business e. allotment

2. Members that need special care (Indicate number)

Physical & mental Needing Assistance Needing Special Seriously Ill Pregnant
disabilities to Walk Medical Care

3. Employment Status of HH head: __Fully-Employed ____Partly-Employed __Unemployed

3.1 If employed, type of employer: ___government ___private ____semi-private

3.2 Tenurial status: ___permanent ___temporary ___casual __seasonal (project-based worker)
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4. If self-employed, nature of work: ___retail (buy and sell) ___distribution ____service ___insurance

___real property __animal raising __growing crops/garden ___others, please specify: ____________________

5. Has the HH head been included in the 2014 survey of the barangay:____Yes___No____Don’t know

III. MEMBERSHIP IN FUNDING AGENCIES/ IMCRO FINANCE INSTITUTIONS (MFIs)/ COOP

1. Are you a member of any of the following funding agencies:

1.1 SSS ___Yes ___No

1.2 GSIS ___Yes ___No
1.3 PAG-IBIG ___Yes ___No

1.4 Cooperative ___Yes, pls. specify:____________________________________________ ___No

1.5 Others ___Yes, pls. specify:____________________________________________ ___No

2. Are there other members of the household who are members of any of the funding agencies/MFI/Coop?
___Yes ____No

2.1 If there are, how many? ___one ___two ___three or more

2.2 How are you related to them? ____my spouse _____my children _____my in-laws

____others, specify: ______________________________________________________________________

IV. Information on Housing and Lot

1. House/Structure Ownership Status: ___owns the structure/house ___owns the lot ___owns the structure & lot

___owner, mortgaged 1.1 If owned and mortgaged, to whom? ______________________________

___rents entire house/structure ___rents a room in the house/structure ___stays in the house/structure for free

1.2 If you are a renter or occupies the house/structure for free, who is the house owner? _____________________

1.3 Where is the owner living now? ________________________________

2. How old is the house structure? ________

3. Current type of house structure:

___a. single detached ___ b. duplex ___ c. 2-storey ______d. one-storey with loft ____e. row house

4. Type* of housing material:____a. salvaged ____b. light ____ c. mixed _____d. strong
Salvaged: tin, plastic, cardboard etc. Light: Nipa cogon, bamboo, wood
Mixed: mixture of light and strong materials Strong: CHB, GI sheets, wood, concrete

5. Lot Ownership Status: a. owner, free from liens and encumbrances

b. renter
c. rent-free
d. owner, mortgaged

5.1 If lot is not owned: a.) Name of lot owner________________________________

b.) Name of lot lessor________________________________

c.) Name of structure owner _____________________________

d.) Name of structure lessor _____________________________

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6. Current use of structure:
Type Floor Area (estimated)
6.1 Business only
___a. parlor ___ b. store ___c. carinderia
___d. computer shop ___e. others__________________
6.2 Residential with Business
___a. parlor ___ b. store ___ c. carinderia
___d. computer shop ___e. computer shop
___f. others______________________________
6.3 Residential only
___a. apartment ___b. single detached
___c. duplex ___d. row house

7. Electric Source
___a. owns PECO meter ___b. connection to neighbors ____c. none ___d. generator

8. Average monthly electric bill with PECO: ____________________

9. Sources of household water? (check as many as possible)

____a. NAWASA ___b. Artesian well ___c. buy water ___d. others

10. If you are tapping NAWASA water source, how much is the average monthly billing? _________

V. Housing Preference and Affordability

1. Are you interested in owning a house and lot or lot only?

Yes No
House and Lot
Lot Only

2. Preference in lot location:

___a. corner lot ___b. adjacent to family/relative ___c. anywhere ___d. front near road ___e. near open space

3. If you are interested in house and lot, what house model do you prefer?
___a. single detached ___ b. duplex ___ c. two-storey ___ d. row house ____e) one-storey with loft

4. Preferred terms of payment: ___cash ____installment

4.1 If installment, how many years to pay?_____ 4.2 How much are you willing to pay monthly?Php________

5. How much is your affordability for housing amortization per month? Php _____________

6. Have you applied for a housing loan either as principal owner or co-borrower with any of the funding agencies?

___ a. Yes (specify)_______________

___ b. No

7. Do you want to avail of a government-owned housing unit? ___ a. Yes ___ b. No

6. Are you capable of raising additional funds for payment of equity in the acquisition of housing unit/lot?
___ 6.1 Yes _____ 6.2 How much ___ 6.3 No

VI. Perceptions of the Respondent

1. How do you feel about your uncertain ownership of the property?

___ a. discontented/ unsatisfied
___ b. worried when the time comes that landowner will use the property and we are obliged to vacate
___ c. not worried
___ d. contended
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2. Have you already received summons? _____Yes _____No

3. What type of lot ownership would you prefer?

______a) usufruct ______b) individual title _______c) collective title ____e) donation

4. What fees have you already paid for related to the lot?

____________________________________________________________________________________________

MADAMU NGA SALAMAT