REPUBLIC OF THE PHILIPPINES

PROVINCE OF LA UNION
MUNICIPALITY OF BAUANG
BARANGAY ACAO
HOUSEHOLD PROFILE

BHW: ______________________ HH NO. ____________________

PUROK: ____________________ CONTACT NO. __________________ FAMILY NO. _________________
FAMILY HEAD: _______________ NHTS HH NO. ________________
DATE SURVEYED: _____________ 4P’S NO. ____________________

NAME BIRTHDATE AGE GENDER OCCUPATION EDUCATIONAL

RELATIONSHIP
HEAD/SPOUSE/MEMBERS MM/DD/YY ATTAINMENT

TO PH
LAST NAME FIRST NAME MIDDLE NAME M F