Republic of the Philippines

Province of Cebu
Municipality of Argao 2”x2”
Barangay Cansuje ID PICTURE
0FFICE OF SANGGUNIANG KABATAAN

“COMPREHENSIVE ACTION ON RE-STRENGTHENEN LEARNING OUTCOMES”

FREE WIFI BENEFICIARY FORM
Instruction: Fill in the required information. Do not leave an item blank. If item is not applicable, indicate “N/A”
PERSONAL INFORMATION

Last Name ` First Name Middle Name

Date of Birth  MAC Address of the device  

Place of Birth    to be connected to the WIFI  
Sex male female Zip Code  

Civil Status single widowed School Name  

married separated School Address  

annulled others    

Citizenship   School Type Public Private

Mobile Number   Highest Grade/ Year  

E-mail Address   Type of Disability (if  
applicable)
FAMILY BACKGROUND
Father living deceased Mother living deceased

Name      
Address      
Occupation      
Educational      
Attainment
Total Parents Gross   No. of siblings in the family:
Income
School Intended to  
enroll in
School Address  
Type of School Public Private

Course Priority Non-Priority

     

_______________________________ ______________________
(Signature over Printed Name) Date Accomplished

Note: Fully Accomplished Form to be submitted to the Office of the Sangguniang Kabataan of Cansuje
 FREE WIFI BENEFICIARY TERMS AND CONDITIONS

Our enjoyment of the government’s service comes with social responsibilities. We should not only ask what the
government can do for us but what we can give back to the government.

The free wifi benefits is being incentivized to give the youth an opportunity to become productive citizens. This would
enable us to become proactive citizens and be part of the solution rather than a problem in our community.

To be able to enjoy this benefits you:

1. Must pay Php 150.00 monthly fee equivalent to Php 5.00/day (unlimited use). This will be used to fund for the
developmental projects/activities and other needs of the members of the free wifi beneficiaries.
2. Must be an active member in our facebook group for announcement.
3. Must attend the monthly meeting of the free wifi members.
4. Must join/participate in the SK projects/activities and Free Wifi Member’s activities.
(Addiitonal guidelines/rules might be created for the harmonious implementation of this program)

Failure to comply with any of the conditions set above will result in the forfeiture of the benefits you are enjoying.

By signing this form you agree to the terms and conditions stipulated herein.

________________________________________________________

SIGNATURE OVER PRINTED NAME