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FORM 1

REPUBLIC ACT 10361 "BATAS KASAMBAHAY"


BARANGAY LIST ( an Act instituting policies for the protection and welfare of domestic workers.)
Month of JANUARY 2017
C.Y. 2017

BARANGAY: NINE

AGES Total Number of


TOTAL NUMBER
PUROK MALE FEMALE 61 AND Kasambahay w/
of Kasambahay
15-20 21-25 25-30 31-35 36-40 41-50 51-60 ABOVE Philhealth
1
2 39 22 17 10 15 2 5 2 4 1 11
3
4
5 13 5 8 5 6 1 1
6
7
8 2 2 2
TOTAL 54 27 27 15 23 3 6 2 4 1 0 11

SUBMITTED BY: APPROVED BY:

MARILYN S. VILLAROSA RODRIGO


Barangay Secretary

Importance:
*Protection of the rights of domestic workers against abuse, harassment, violence, economic exploitation and 6
performance of work that is hazardous to their physical and mental health; and the protection of domestci workers
and recognizing their special needs to ensure safe and healthful working conditions, promotes gender sensitive
measures in the formulation and implementation of policies and programs affecting the local domestic work.
* FORM TO BE SUBMITTED TO THE D
* CONSOLIDATED FORM
"
stic workers.)

Total Number of Total Number of


Kasambahay w/ SSS Kasambahay w/ Pag-ibig

5 2

5 2

RODRIGO B. TIMONES
Punong Barangay
SUBMITTED TO THE DILG OFFICE
FORM 1
REPUBLIC ACT 10361 "BATAS KASAMBAHAY"
BARANGAY LIST ( an Act instituting policies for the protection and welfare of domestic workers.)
Month of AUGUST 2016
C.Y. 2016

BARANGAY: NINE

AGES Total Number of


TOTAL NUMBER
PUROK MALE FEMALE 61 AND Kasambahay w/
of Kasambahay
15-20 21-25 25-30 31-35 36-40 41-50 51-60 ABOVE Philhealth
1
2 39 22 17 10 15 2 5 2 4 1 11
3
4
5 13 5 8 5 6 1 1
6
7
8 2 2 2
TOTAL 54 27 27 15 23 3 6 2 4 1 0 11

SUBMITTED BY: APPROVED BY:

MARILYN S. VILLAROSA RODRIGO


Barangay Secretary

Importance:
*Protection of the rights of domestic workers against abuse, harassment, violence, economic exploitation and 6
performance of work that is hazardous to their physical and mental health; and the protection of domestci workers
and recognizing their special needs to ensure safe and healthful working conditions, promotes gender sensitive
measures in the formulation and implementation of policies and programs affecting the local domestic work.
* FORM TO BE SUBMITTED TO THE D
* CONSOLIDATED FORM
"
stic workers.)

Total Number of Total Number of


Kasambahay w/ SSS Kasambahay w/ Pag-ibig

5 2

5 2

RODRIGO B. TIMONES
Punong Barangay
SUBMITTED TO THE DILG OFFICE
FORM 1
REPUBLIC ACT 10361 "BATAS KASAMBAHAY"
BARANGAY LIST ( an Act instituting policies for the protection and welfare of domestic workers.)
Month of JULY 2016
C.Y. 2016

BARANGAY: NINE

AGES Total Number of


TOTAL NUMBER
PUROK MALE FEMALE 61 AND Kasambahay w/
of Kasambahay
15-20 21-25 25-30 31-35 36-40 41-50 51-60 ABOVE Philhealth
1
2 39 22 17 10 15 2 5 2 4 1 11
3
4
5 13 5 8 5 6 1 1
6
7
8 2 2 2
TOTAL 54 27 27 15 23 3 6 2 4 1 0 11

SUBMITTED BY: APPROVED BY:

MARILYN S. VILLAROSA RODRIGO


Barangay Secretary

Importance:
*Protection of the rights of domestic workers against abuse, harassment, violence, economic exploitation and 6
performance of work that is hazardous to their physical and mental health; and the protection of domestci workers
and recognizing their special needs to ensure safe and healthful working conditions, promotes gender sensitive
measures in the formulation and implementation of policies and programs affecting the local domestic work.
* FORM TO BE SUBMITTED TO THE D
* CONSOLIDATED FORM
"
stic workers.)

Total Number of Total Number of


Kasambahay w/ SSS Kasambahay w/ Pag-ibig

5 2

5 2

RODRIGO B. TIMONES
Punong Barangay
SUBMITTED TO THE DILG OFFICE
FORM 1
REPUBLIC ACT 10361 "BATAS KASAMBAHAY"
BARANGAY LIST ( an Act instituting policies for the protection and welfare of domestic workers.)
Month of JUNE 2016
C.Y. 2016

BARANGAY: NINE

AGES Total Number of


TOTAL NUMBER
PUROK MALE FEMALE 61 AND Kasambahay w/
of Kasambahay
15-20 21-25 25-30 31-35 36-40 41-50 51-60 ABOVE Philhealth
1
2 39 22 17 10 15 2 5 2 4 1 11
3
4
5 13 5 8 5 6 1 1
6
7
8 2 2 2
TOTAL 54 27 27 15 23 3 6 2 4 1 0 11

SUBMITTED BY: APPROVED BY:

MARILYN S. VILLAROSA RODRIGO


Barangay Secretary

Importance:
*Protection of the rights of domestic workers against abuse, harassment, violence, economic exploitation and 6
performance of work that is hazardous to their physical and mental health; and the protection of domestci workers
and recognizing their special needs to ensure safe and healthful working conditions, promotes gender sensitive
measures in the formulation and implementation of policies and programs affecting the local domestic work.
* FORM TO BE SUBMITTED TO THE D
* CONSOLIDATED FORM
"
stic workers.)

Total Number of Total Number of


Kasambahay w/ SSS Kasambahay w/ Pag-ibig

5 2

5 2

RODRIGO B. TIMONES
Punong Barangay
SUBMITTED TO THE DILG OFFICE
FORM 1
REPUBLIC ACT 10361 "BATAS KASAMBAHAY"
BARANGAY LIST ( an Act instituting policies for the protection and welfare of domestic workers.)
Month of _______________________
C.Y. 2016

BARANGAY: MAPAYAG

AGES Total Number of


TOTAL NUMBER
PUROK MALE FEMALE 61 AND Kasambahay w/
of Kasambahay
15-20 21-25 25-30 31-35 36-40 41-50 51-60 ABOVE Philhealth
1
2
3
4
5
6
7
8
TOTAL 0 0 0 0 0 0 0 0 0 0 0 0

SUBMITTED BY: APPROVED BY:

MARILYN S. VILLAROSA RODRIGO


Barangay Secretary

Importance:
*Protection of the rights of domestic workers against abuse, harassment, violence, economic exploitation and 6
performance of work that is hazardous to their physical and mental health; and the protection of domestci workers
and recognizing their special needs to ensure safe and healthful working conditions, promotes gender sensitive
measures in the formulation and implementation of policies and programs affecting the local domestic work.
* FORM TO BE SUBMITTED TO THE D
* CONSOLIDATED FORM
orkers.)

Total Number of Total Number of


Kasambahay w/ SSS Kasambahay w/ Pag-ibig

0 0

RODRIGO B. TIMONES
Punong Barangay
SUBMITTED TO THE DILG OFFICE
FORM 1
REPUBLIC ACT 10361 "BATAS KASAMBAHAY"
BARANGAY LIST ( an Act instituting policies for the protection and welfare of domestic workers.)
Month of DECEMBER 2015
C.Y. 2015

BARANGAY: NINE

AGES Total Number of


TOTAL NUMBER
PUROK MALE FEMALE 61 AND Kasambahay w/
of Kasambahay
15-20 21-25 25-30 31-35 36-40 41-50 51-60 ABOVE Philhealth
1
2 39 22 17 10 15 2 5 2 4 1 11
3
4
5
6
7
8 2 2 2
TOTAL 41 22 19 10 17 2 5 2 4 1 0 11

SUBMITTED BY: APPROVED BY:

MARILYN S. VILLAROSA RODRIGO


Barangay Secretary

Importance:
*Protection of the rights of domestic workers against abuse, harassment, violence, economic exploitation and 6
performance of work that is hazardous to their physical and mental health; and the protection of domestci workers
and recognizing their special needs to ensure safe and healthful working conditions, promotes gender sensitive
measures in the formulation and implementation of policies and programs affecting the local domestic work.
* FORM TO BE SUBMITTED TO THE D
* CONSOLIDATED FORM
orkers.)

Total Number of Total Number of


Kasambahay w/ SSS Kasambahay w/ Pag-ibig

5 2

5 2

RODRIGO B. TIMONES
Punong Barangay
SUBMITTED TO THE DILG OFFICE
FORM 1
REPUBLIC ACT 10361 "BATAS KASAMBAHAY"
BARANGAY LIST ( an Act instituting policies for the protection and welfare of domestic workers.)
MONTH OF JANUARY
C.Y. 2016

BARANGAY: NINE

AGES Total Number of


TOTAL NUMBER
PUROK MALE FEMALE 61 AND Kasambahay w/
of Kasambahay
15-20 21-25 25-30 31-35 36-40 41-50 51-60 ABOVE Philhealth
1
2 39 22 17 10 15 2 5 2 4 1 11
3
4
5
6
7 2 2 2
8

SUBMITTED BY: APPROVED BY:

MARILYN S. VILLAROSA RODRIGO


Barangay Secretary

Importance:
*Protection of the rights of domestic workers against abuse, harassment, violence, economic exploitation and 6
performance of work that is hazardous to their physical and mental health; and the protection of domestci workers
and recognizing their special needs to ensure safe and healthful working conditions, promotes gender sensitive
measures in the formulation and implementation of policies and programs affecting the local domestic work.
* FORM TO BE SUBMITTED TO THE D
* CONSOLIDATED FORM
orkers.)

Total Number of Total Number of


Kasambahay w/ SSS Kasambahay w/ Pag-ibig

5 2

RODRIGO B. TIMONES
Punong Barangay
SUBMITTED TO THE DILG OFFICE
FORM 1
REPUBLIC ACT 10361 "BATAS KASAMBAHAY"
BARANGAY LIST ( an Act instituting policies for the protection and welfare of domestic workers.)
MONTH OF FEBRUARY 2016
C.Y. 2016

BARANGAY: NINE
* By Purok/Zone/Sector/Sitio ________

PUROK NAME GENDER AGE CHECK, if member


Philhealth SSS Pag-ibig
1
2

2
3
4
5
6
7

SUBMITTED BY: APPROVED BY:

MARILYN S. VILLAROSA
Barangay Secretary

Importance:
*Protection of the rights of domestic workers against abuse, harassment, violence, economic exploitation and
performance of work that is hazardous to their physical and mental health; and the protection of domestci workers
and recognizing their special needs to ensure safe and healthful working conditions, promotes sender sensitive
measures in the formulation and implementation of policies and programs affecting the local domestic work.
* TO BE USED BY BARANGAY FOR DATE GATHERING
* TO BE KEPT BY BRGY. SECRETARY ONLY
* DATA WILL BE USED TO FILL UP FORM 2
MBAHAY"
and welfare of domestic workers.)
16

MONTHLY
Complete Name of Employer/s
SALARY

ROVED BY:

RODRIGO B. TIMONES
Punong Barangay

O BE USED BY BARANGAY FOR DATE GATHERING


O BE KEPT BY BRGY. SECRETARY ONLY
ATA WILL BE USED TO FILL UP FORM 2
FORM 1
REPUBLIC ACT 10361 "BATAS KASAMBAHAY"
BARANGAY LIST ( an Act instituting policies for the protection and welfare of domestic workers.)
MONTH OF _________________________
C.Y. 2015

BARANGAY: NINE

AGES Total Number of


TOTAL NUMBER
PUROK MALE FEMALE 61 AND Kasambahay w/
of Kasambahay
15-20 21-25 25-30 31-35 36-40 41-50 51-60 ABOVE Philhealth
1
2 39 22 17 10 15 2 5 2 4 1
3
4
5
6
7
8

SUBMITTED BY: APPROVED BY:

MARILYN S. VILLAROSA RODRIGO


Barangay Secretary

Importance:
*Protection of the rights of domestic workers against abuse, harassment, violence, economic exploitation and 6
performance of work that is hazardous to their physical and mental health; and the protection of domestci workers
and recognizing their special needs to ensure safe and healthful working conditions, promotes gender sensitive
measures in the formulation and implementation of policies and programs affecting the local domestic work.
* FORM TO BE SUBMITTED TO THE D
* CONSOLIDATED FORM
orkers.)

Total Number of Total Number of


Kasambahay w/ SSS Kasambahay w/ Pag-ibig

RODRIGO B. TIMONES
Punong Barangay
SUBMITTED TO THE DILG OFFICE
FORM 1
REPUBLIC ACT 10361 "BATAS KASAMBAHAY"
BARANGAY LIST ( an Act instituting policies for the protection and welfare of domestic workers.)
MONTH OF FEBRUARY 2016
C.Y. 2016

BARANGAY: NINE
* By Purok/Zone/Sector/Sitio ________

PUROK NAME GENDER AGE CHECK, if member


Philhealth SSS Pag-ibig
1
2
3
4
5
6

7
7
8
9
10
11
12
13
14
15
5
ASAMBAHAY"
on and welfare of domestic workers.)
2016

Complete Name of Employer/s MONTHLY SALARY

5
55
60
3.6
63.6

0.8

108000
113