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  • Registration Form (Locally Stranded Individual) : Annex A

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    Edison Labastida
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    1) The document is a registration form for locally stranded individuals (LSIs) that collects personal information such as name, address, contact details, age, occupation, emergency contacts, origin and destination locations. 2) It also requests transportation details if available and confirms that the LSI has obtained medical clearance from the city or municipal health office by meeting one of three health conditions. 3) The form notes that fields marked with an asterisk are mandatory while information marked with two asterisks is optional if available.

    Original Description:

    Original Title

    LSI FORM

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    1) The document is a registration form for locally stranded individuals (LSIs) that collects personal information such as name, address, contact details, age, occupation, emergency contacts, origin and destination locations. 2) It also requests transportation details if available and confirms that the LSI has obtained medical clearance from the city or municipal health office by meeting one of three health conditions. 3) The form notes that fields marked with an asterisk are mandatory while information marked with two asterisks is optional if available.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    181 views1 page

    Registration Form (Locally Stranded Individual) : Annex A

    Uploaded by

    Edison Labastida
    1) The document is a registration form for locally stranded individuals (LSIs) that collects personal information such as name, address, contact details, age, occupation, emergency contacts, origin and destination locations. 2) It also requests transportation details if available and confirms that the LSI has obtained medical clearance from the city or municipal health office by meeting one of three health conditions. 3) The form notes that fields marked with an asterisk are mandatory while information marked with two asterisks is optional if available.

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Annex A

    Registration Form
    (Locally Stranded Individual)

    *Last Name: *First Name: *Middle Name: Suffix:

    *Gender: *Complete Address: Region, *Contact Number: *Age:


    Male Female Province, City/Mun. Brgy.

    *Occupation: **Emergency Contact Person *Origin LGU: *Date of Travel


    and Contact Number: Region, Province, City/Mun.Brgy to Residence:

    *Destination LGU: **Vehicle: **Driver's Name and *Date of Travel


    Region, Province, City/Mun. Private Government Contact Number: to Residence:
    Brgy

    Medical Clearance Issued by the City/Municipal A Medical Clearance Certification issued by the City/Municipal
    Health Office: Health Office based on the following conditionsL
    Yes, Date of Issuance: _______________________ • That the LSI is neither a contact, suspect or probable or
    No, Reason: ______________________________ confirmed COVID-19 case, and
    • That the LSI completed a 14-day quarantine based on the
    quarantine standards set by the DOH: or
    • That LSI confirmed as a COVID-19 case was tested
    negative through RT-PCR twice.

    Note:
    * - Mandatory
    ** - If available

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