RBI Form B

INDIVIDUAL RECORD OF BARANGAY INHABITANT

REGION:

PROVINCE:

CITY:

BARANGAY:

PERSONAL INFORMATION
NAME:

(LAST) (FIRST) (MIDDLE) (EXT)

DATE OF BIRTH: PLACE OF BIRTH:

MM DD YYYY

SEX: MARITAL STATUS:

MAL FEMAL SINGL MARRIE WIDOW/E SEPARATED

E E E D R

CITIZENSHIP: PROFESSION/OCCUPATION

RESIDENCE ADDRESS:

HOUSE NO. STREET NAME PUROK/ZONE SITIO

I hereby certify that the above information is true and correct to the best of my knowledge.

______________________ _________________________________________________
Date Accomplished Name and Signature of the Person Accomplishing the Form

Attested by:

GLENN C. GABULE RN
Barangay Secretary

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Note: The Household No. Shall be filled up by the Barangay Secretary.