Record of Barangay Inhabitants by Household: C O D E S

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RBI FORM A

RECORD OF BARANGAY INHABITANTS BY HOUSEHOLD


A. REGION: PSG
B. PROVINCE:
C
C. MUNICIPALITY: O
D
E
D. BARANGAY: S

E. HOUSEHOLD NO.:
DATE ACCOMPLISHED:

NAME (1) ADDRESS (2)


CIVIL CITIZEN-
PLACE OF BIRTH DATE OF BIRTH SEX OCCUPATION
LAST NAME FIRST NAME MIDDLE NAME EXT NO. NAME OF STATUS SHIP
STREET NAME (2.2) SUBDIVISION/ZONE/SITIO/PURO (3) (4) (5) (6) (7) (8)
(1.1) (1.2) (1.3) (1.4) (2.1) K (if applicable) (2.3)

Prepared by: Certified Correct: Validated by:

FATIMA D. ASAO MAMA T. BAKAR


Name of Household Head/Member Barangay Secretary Punong Barangay
RBI Form B

INDIVIDUAL RECORD OF BARANGAY INHABITANT


REGION CITY/MUN

PROVINCE BGY

I. PERSONAL INFORMATION
NAME:
(Last) (First) (Middle) (Ext)
DATE OF BIRTH: PLACE OF BIRTH:
MM DD YYYY
SEX: MALE CIVIL STATUS: SINGLE WIDOW/ ER
FEMALE MARRIED SEPARATED
CITIZENSHIP:
PROFESSION/OCCUPATION:
RESIDENCE ADDRESS:
House No Street Name

Subdivision Name/Zone/Sitio/Purok

I hereby certify that the above information is true and correct to the best of my knowledge.

Date Accomplished Name/Signature of Person Accomplishing the Form

Attested by:

Left Right
Thumbmark Thumbmark

Barangay Secretary

Household Number
Note: The Household No. shall be filled up by the Barangay Secretary.

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