INFORMATION SHEET

NAME OF CHILD: _________________________________________________________ DATE OF BIRTH: __________________ _____, _________

(PANGALAN NG E-REHISTRO) FIRST NAME MIDDLE NAME LAST NAME MONTH DAY YEAR

PLACE OF BIRTH: __________________________________________________ SEX: BABAE TIME: ___________

MUNICIPALITY PROVINCE LALAKI
BIRTH ORDER: ______________ WEIGHT OF CHILD: __________________
Total Number of Children No. of children still living No. of children born alive
born alive: _________ including this birth: ___________ but are now dead: ____________

MOTHER
(BUONG PANGALAN NG MAMA SA PAGKADALAGA)
NAME: ____________________________________________________________
FIRST NAME MIDDLE NAME LASTNAME

EDAD NONG IPINANGANAK KA: _______________ RELIHIYON: _________________________

TRABAHO: _____________________________ USUAL RESIDENCE: _______________________________________________________

FATHER
NAME: ____________________________________________________________
FIRST NAME MIDDLE NAME LASTNAME

EDAD NONG IPINANGANAK KA: _______________ RELIHIYON: _________________________

TRABAHO: _____________________________ USUAL RESIDENCE: _______________________________________________________

MARRIAGE OF PARENTS

PETSA NG KASAL: ____________________________ PLACE OF MARRIAGE: _______________________________________________

PANGALAN NG NAGPA-ANAK: ____________________________________________ ADDRESS: _________________________________