ASF Depopulation Form

Province: ________________
Municipality: ________________
Barangay: ________________
Date: ________________

No. Name of Hog Raiser Address and Contact Number Sow Boar Fattener/Grower Weanlings GPS Signature
Coordinates
No. of Heads No. of Heads No. of Heads No. of
Heads
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

Conducted by: Certified By: Attested and Verified by:

_____________________ ___________________________ _________________________

Barangay Representative City/Municipal Veterinary Office/ Provincial Veterinary Office/
City/Municipal Agriculture office Provincial Agriculture Office
Signature over Printed Name Signature over Printed Name