Form No. BF-01 CONTROL NO.

:
REPUBLIC OF THE PHILIPPINES FAMILY :
PROVINCE OF CAVITE
MUNICIPALITY OF SILANG
BARANGAY LITLIT

BARANGAY CENSUS FORM

Note: Please write LEGIBLY (Pakisulat ng Mababasa)

Last Name (Apilyido) First Name (Pangalan) Middle Name Initial Name (Palayaw)

Present Address (Kasalukuyan Tirahan)

House Number Purok/Street Barangay Municipality/City Province

Provincial Address (Tirahan sa Probinsiya)

House Number Purok/Street Barangay Municipality/City Province

Date of Birth (dd/mm/yyyy) Place of Birth Nationality Religion Sex

(Buwan/Araw/Taon Ipinanganak) (Saan ka ipinanganak?) (Nasyonalidad) (Relihiyon) (Lalaki o Babae)

Height (inches) Weight (kilos) Contact No. Email:

(Taas) (Timbang)

Marital Status (Estado sa Buhay)

Single Married Separated Widow(er) Divorced
(Walang Asawa) (May Asawa) (Hiwalay sa Asawa) (Biyudo/Biyuda) (Diborsyado)

Mother's Maiden Name (Last Name, First Name, Middle Name)

Father's Name (Last Name, First Name, Middle Name)

EDUCATION ATTAINMENT
Please give exact titles of degrees in original language. Do not translate or equate to other degrees. (Isulat ang wastong baitang o kursong natapos.)
Name and Address of School Address
(Pangalan at Address ng Paaralan)
Elementary:
Highschool:
Vocational/Course:
College/Course:
EMPLOYMENT RECORD
Starting with your present post, list in REVERSE ORDER your employment history. (Mula sa kasalukuyang posisyon, ilista nang pabalik ang mga
trabahong napasukan.)
Duration (Tagal) Name of Employer (Pangalan ng Kumpanya) Address

OTHER HOUSE OCCUPANTS

Name Position in the family Age Birth of Date Civil status

I certify that the statements made by me in answering the foregoing questions are true, complete and correct to the
best of my knowledge and belief. (Ang lahat ng ibinigay na kasagutan sa mga naunang katanungan ay dinedeklara kong totoo,
kumpleto at tama sa aking buong kaalaman at paniniwala.)

Date (day/month/year) : ___________________________ Signature