RBI FORM A

RECORD OF BARANGAY INHABITANTS BY HOUSEHOLD

A. REGION PSG
C
B. PROVINCE
O
C. CITY/MUNICIPALITY D
E
D. BARANGAY S

E. HOUSEHOLD NO. DATE ACCOMPLISHED

NAME (1) ADDRESS (2)

STREET NAME OF PLACE OF BIRTH DATE OF BIRTH SEX SIVIL CITIZENSHIP OCCUPATION
LAST NAME FIRST NAME MIDDLE NAME EXT NO. NAME SUBDIVISION/ZONE (3) (4) (5) STATUS (7)
(1.1) (1.2) (1.3) (1.4) (2.1) SITIO/PUROK (if (6) (8)
(2.2) 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)