FORM B

HOUSEHOLD
RECORD OF BARANGAY INHABITANTS (RBI)

A. REGION : VII A. 1 PSGC: ___________________

B. PROVINCE : BILIRAN B. 1 PSGC: ___________________
C. MUNICIPALITY : CULABA C. 1 PSGC: ___________________
D. BARANGAY : POBLACION D. 1 PSGC:___________________
E. HOUSEHOLD No :

NAME ADDRESS
(1) (2) PLACE DATE SEX CIVIL OCCUPATION RELATIONSHIP
NAME OF OF BIRTH OF BIRTH (5) STATUS CITIZENSHIP (8) TO
LAST FIRST MIDDLE QUALIFIER NUMBER STREET NAME SUBD/ZONE/SITIO/ (3) (4) (6) (7) HOUSEHOLD
(1.1) (1.2) (1.3) (1.4) (1.5) (1.6) PUROK HEAD (9)
(1.7)

Legend:
Philippine Standard Geographic Code shall be made available by the DILG City/Municipal Offices
Household is a social unit consisting of a person living alone or a group of person who
1) sleep in the same housing unit and 2) have a common arrangement in the preparation and consumption of food
Qualifier is the additional and/or inclusion of the word “JR.”, “SR.”, “II”, etc as the case maybe after the person’s surname(s)

Prepared by: Certified Correct: Validated by:

ARVIN CONSTANTINE TAGNIPES NANCY P. ARPON NANCY P. ARPON

Barangay Secretary Punong Barangay Punong Barangay