RBI FORM B

HOUSEHOLD
RECORD OF BARANGAY INHABITANTS
A. REGION: A. 1 PSGC:
B. PROVINCE: B. 1 PSGC
C. CITY/MUNICIPALITY: C. 1 PSGC
D. BARANGAY: D. 1 PSGC
E. HOUSEHOLD NO.:

NAME ADDRESS
(1) (2)
RELATIONSHIP
PLACE OF CIVIL
BIRTH DATE OF SEX STATUS CITIZENSHIP OCCUPATION TO HOUSEHOLD
NAME OF HEAD
LAST FIRST MIDDLE QUALIFIER NUMBER STREET NAME SUBD/ZONE/SITI BIRTH
O/PUROK

(1.1) (1.2) (1.3) (1.4) (2.1) (2.2) (2.3)

Legend
PSGC: Philippine Standard Geographic Code shall be made available by the DILG City/Municipal Officer
HOUSEHOLD is a social unit consisting of person living alone or group of persons who
1) sleep in the same housing unit; and 2) have a common arrangement in the preparation and consumption of food.
QUALIFIER is the addition and/or inclusion of the word "jr." "SR." etc. as the case maybe after the person's surname(s)

prepared by: Certified Correct: Validated by:

Barangay Secretary Punong Barangay