Republic of the Philippines Attach Photo Here

Province of ________________
(1 1/2" x 1 1/2")
Municipality of _________________
Photo should be taken
APPLICATION FOR MUNICIPAL FISHERFOLK REGISTRATION within the last six (6)
months
Registration No.: New Registration Transferee
Registration Date: Renewal
1. PERSONAL INFORMATION
Complete Name
Mr Ms Mrs
Salutation Last Name First Name Middle Name Appellation (Sr, Jr, III)
Address

Street/Barangay City/Municipality Province

Fishing FMA
Ground: Number: Full Time Part Time

Contact No. (Cellphone, Telephone) Resident of Municipality since

(Indicate the year)

Age Date of Birth Place of Birth (Munic ipality , Prov inc e)

(MM - DD - Y Y Y Y)
Sex Civil Status No. of Children
Male Female Single Legally Separated
Married Widowed

Total Number of Households: ____________

No. of Male: No. of In-School: No. of Employed: _________
No. of Female: No. of Out-of-School: No. of Unemployed: _________

Educational Background
Elementary Vocational Post- Graduate

High School College Others (pls. specify)

Nationality
Filipino
Others (pls. specify)

Other Source of Income

Farming/Fishing:_________________ Income Value: ________________

Person to notify in case of emergency: Relationship: Contact No. (Cellphone, Telephone)

(First Name, Last Name)

Address: (Barangay, Municipality, Province)

With Voter's ID? CCT/4Ps

ID No. Yes
Yes
No No

Indigenous Cultural Community (IP)?

Yes
No
Barangay Verification (verifed true and corrected by)

Signature Name Position Date

MFRS FORM DA-BFAR | WWW.BFAR.DA.GOV.PH

2. LIVELIHOOD

Main Source of Income: Other Sources of Income:

Capture Fishing (specify gear used) Capture Fishing (specify gear used)
Aquaculture (specify gear used) Aquaculture (specify gear used)
Fish vending Fish vending
Gleaning Gleaning
Fish Processing Fish Processing
Others (pls. specify) Others (pls. specify)

3. ORGANIZATION

Name of Organization Member Since Position/Official Designation

4. CERTIFICATION THUMBMARK
I have personally reviewed the information on this application and I certify under penalty of perjury
that to the best of my knowledge and belief the information on this application is true and correct,
and that I understand this information is subject to public
(Signature over printed name of Applicant) Date Accomplished

5. FOR AUTHORIZED PERSONNEL ONLY

Reviewed by: Certified correct by: Approved by:
(Signature over printed name) (Signature over printed name) (Signature over printed name)

MFRS FORM DA-BFAR | WWW.BFAR.DA.GOV.PH