Name of School/Church/Barangay:

Address:
Focal/Contact Person:
Mobile Number:
FB Messenger Account Name:

LIST OF REGISTRANTS FOR VERIFICATION UNDER PBRAP

Birthday BirthPlace
Name of Person to be registered (Mon./Day/Year) (City/Municipality- Mother's Full Maiden Name Father's Full Name Contact Number
No. Province)
(1) (2) (3) (4) (5) (9)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20