INDIVIDUAL RECORD OF BARANGAY INHABITANTS HOUSEHOLD NUMBER (HN) region = [WN] E[R vers [bo] a] s[MlAl®] i [A] 4] 5 PERSONAL INFORMATION Sur | i T I ‘surname | I | T veirst name [ Middle Name | Extension House No. ‘Street Kal = Yaddeess I Name ol Subdivision /Zane / Sitio / Purok / Barangay / Baro | | | J iy /Muripaly Frovinee Date of Birth meat g ]- V3irth Place] L | ¥5ex Male Female Yeo Sratus Isnge [|oeries operated [_ Joot/Sigle Parent Dependent ‘Ago Gander YDecupation I nein im] Relationship to Household Head ¥ mployer Name I Contact No, | hereby certify that the above ‘nformation are true and correct to thebestof rry know edge. Tame | Signatore of Person Accomplishing Sis Farm Dore Aecomplihed attested by: Barangay secretary Te Thomomerk Fight Thumbrmark (in case inhabitant & unable to read and write) Note: The HN shall be file¢ 1p by the Barangay Secretary