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REPUBLIC OF THE PHILIPPINES

PROVINCE OF BULACAN
BULAKENYO BNS/ML/VOLUNTEERS
ASSO. INC.

(FORMER BBFI)

DAMAYAN DUES FOR THE YEAR _______________


CITY/MUNICIPALITY OF ______________________

BARANGAY ________________________________

NAME DESIGNATION DATE OF AGE YEAR


BIRTH STARTE
D
LLN/BNS

TOTAL AMOUNT PAID PHP. _________________

SUBMITTED BY:______________________________ DATE:


(NAME OF LLN WITH SIGNATURE OVER PRINTED NAME)

NOTED BY: _________________________________ DATE:


(NAME OF CITY/MUNICIPAL PRESIDENT WITH SIGNATURE OVER PRINTED NAME

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