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LIST OF CLIENTS FOR 2017 CLIENT SATISFACTION SURVEY

AS OF _____________________ 2018

Office/Division/Unit Client Information Status of Service/or Products Availment

SERVICE NAME Status of Participation as Beneficiary ADDRESS Period of Availment

Specific
Services or Date when
AGENCY OFFICE UNIT Contact Number Age Gender Date when
As As Products service or
Office/Scho availed services/pro
DIVISION LAST FIRST MI Individual Representa Street Barangay Municipality /City Province product was
ol ducts was
Beneficiary tion actually
applied
received

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