Dear Valued Client,

I would like to ask for your participation in answering this survey form regarding the
quality of service of the Municipal Civil Registry of Lucban Quezon. I am currently conducting
a study entitle “An Evaluation of the Services Provided by the Civil Registry Office in Lucban
Quezon”. Be assured that your answers will be treated with utmost confidentiality.

Raquel O. Alivio
Researcher

Part 1. Demographic bSurvey. Please provide the necessary information by putting a check
mark on the side provided for in each item.

Name: (optional) _______________________

Age: ____ 18 to 25 years old ____ 46 to 50 years old

____ 26 to 30 years old ____ 51 to 55 years old
____ 31 to 35 years old ____ 56 to 60 years old
____ 36 to 40 years old ____ 61 years old and
____ 41 to 45 years old above

Gender: ____ Male

____ Female

Marital Status:
____ Single
____ Married
____ Separated
____ Annulled

Record / Document requested from the Municipal Civil Registry Office of Lucban
____ Birth Certificate
____ Death Certificate
____ Certificate of Marriage
____ Others, please specify __________________
Part II. Survey on Service Quality

Please state your level of satisfaction on the services of the Municipal Civil Registry
Office of Lucban Quezon as regards the five dimensions of service quality. You may
use the following legends as you put a check mark on your appropriate boxes below:

5 - Excellent
4 – Very Satisfactory
3 – Satisfactory
2 – Fair
1 – Poor

Reliability 1 2 3 4 5

Performing the service right for the first time

Customer expectation is strictly followed

Efficiently carries out the service

Accuracy of the information received

Relevance of the information received

Responsiveness 1 2 3 4 5

Readiness to respond to customers’ request

Keeping the customers informed

Entertain/Greet customers upon serving

The office as convenient operating hours

Willingness to attend to customers’ needs

Assurance 1 2 3 4 5

Making customers feel secure about

transactions

Completeness of information received

Staff are knowledgeable about customers’

concerns
Staff assures the customers’ safety

Staff are courteous with you

Empathy 1 2 3 4 5

Staff have a pleasant demeanor

Staff pays customers personal attention

Staff are polite and ready to entertain questions

Staff always listens to the customers

Staff understands the needs of the customers

Tangibles 1 2 3 4 5

Cleanliness of the office

Staff is appropriately dressed

Has comfortable waiting area

Has entertainment facilities like music,

television, etc.

State-of-the-art documentation