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Republic of the Philippines

Province of Iloilo
Municipality of Miagao
Barangay____________________
WAITINGLIST
As of_____________________________
Complete Name
NO. SEX BIRTHDATE ( mm/d
(Last Name, First Name, Middle Name)

Attested and Approved:

_______________________________ ________________________________ __________


Kagawad on Social Services Senior Citizen Association President P

SALVACON S. PETINGLAY MERCY E. MONTEFRIO


OSCA President Senior Focal President
TE ( mm/day/ year ) OSCA ID NO. REMARKS

____________________________
Punong Barangay

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