KR Form 1

KASAMBAHAY MASTERLIST
Quarterly Report
For the Period July - September 30, 2013
Region:
Province:
City/Mu nicipality:
Barangay:

Educational Employment
Nature of Work
Arrangement
Salary Membership
( Attainment

1. Elem Undergrad 1 -Gen.househelp 1- uve-in 1. P 1, 500 - P1,999 (Write V for Ves, and N for No)
Registration
Civil 2. Elem. Grad (all,round); 2 - live out 2. P2,OOO - P2,499 Name of Employer's Complete
Control Name of Kasambahay Home Address Sex Age 2 -Yaya
Number Status 3. HS Undergrad 3. P2,500 - P4,999 Employer Address
4. HSGrad 3 -Cook 4. P5,OOO and
S. Coil. Undergrad 4 - Gardener above

6. Coil. Grad 5 - Laundryperson

7. Vocational 6-OiIlers SSS Pag-IBIG Phil-Heallh
5 Leon Guinto St., Ermita,
2013-0001 Santos Ana Martinez 2 Zamora St., San Jose 5 25 F 1 2 3 y N N Juan dela Cruz Manila

- "
~

Prepared and submitted by:

(Signature over Printed Name)

Position / Designation
Date: