Republika ng Pilipinas

BARANGAY MAPULANG LUPA

Lungsod ng Valenzuela

APLIKASYON PARA SA PAGHIRAM NG

GAMIT NG BARANGAY
Petsa : __________________

Pangalan:_________________________________________ (R) _________________

Tirahan: ________________________________________________________________

Contact #:_________________________________________ Edad: ____________

Anong GAMIT? :_________________________________________________________

Saan GAGAMITIN? ______________________________________________________

Kailan GAGAMITIN? _________________________________ Oras: _____________

_____________________________
Lagda ng Humiram
Approved By:

________________________________
Kgg. FERNANDO C. FRANCISCO
Punong Barangay