EC Information Board
Name of Evacuation Center:
Location:
Name of Site Manager:
Contact Information:
As of/Date: ___________________________________
No. of Families: _____________________
No. of 4Ps Beneficiaries: _______________
Age Male Female
Infant (0-1 yrs old)
Toddler (1-3 yrs old)
Pre- scholer (4-5 yrs old)
School Age (6-12 yrs old)
Teenage (13-19 yrs old)
Adult (20-59 yrs old)
Senior Citizen(60 yrs old)
TOTAL
No. of Pregnant No. of No. of Persons No. of Single Headed No. of Persons
Women: Breastfeeding With Disabilities: Households: With Serious Illness:
Mothers:
Latrines: Bathing Cubicles: Cooking Health Stations: Women Friendly Child-Friendly
Counters: Spaces: Spaces:
Common Illnesses:
Livestock:
Essential Contacts:
Type: Male Female
EC Information Board
Name of Evacuation Center:
Location:
Name of Site Manager:
Contact Information:
As of/Date: ___________________________________
No. of Families: _____________________
No. of 4Ps Beneficiaries: _______________
Age Male Female
Infant (0-1 yrs old)
Toddler (1-3 yrs old)
Pre- scholer (4-5 yrs old)
School Age (6-12 yrs old)
Teenage (13-19 yrs old)
Adult (20-59 yrs old)
Senior Citizen(60 yrs old)
TOTAL
No. of Pregnant No. of No. of Persons No. of Single Headed No. of Persons
Women: Breastfeeding With Disabilities: Households: With Serious Illness:
Mothers:
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
DISASTER FAMILY ASSISTANCE ACCESS CARD
(DAFAC)
Region: V SerIal No.
Province: MASBATE BENEFICIARY'S COPY
Municipality: AROROY
Barangay PURO
Evacuation Center/Site
HEAD OF THE FAMILY
SURNAME FIRST NAME MIDDLE NAME M F AGE
Date of Birth Occupation Monthly Income
4Ps Beneficiary IP-Type of Ethnicity
Health
Family Members Relationship to Date of Birth Age Gender Educ Occupational Skills Status/ Remarks
Family (See Code)
Casuality
House & lot owner
Code A - Elderly Women B - PWD C.
House/room and lot renter With Children Below 5 D. Pregnant
E. Lactating
House owner & lot renter
House owner, rent free lot with owners' consent Partially Damaged
Housing Condtion:
House owner, rent free lot w/o consent of the owner Totally Damaged
Rent-free house & lot with owner's consent 01 - Dead 03- Missing
Health Condtion:
Rent-free house & lot w/o owner's consent 02- Injured 04-With Illness
CANDELARIA R. VIRTUCIO
Signature/Thumbmark of Family Head Name/Signature of Brgy. Captain
Date Registered Name/ Signature of C/MSWDO
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
DISASTER FAMILY ASSISTANCE ACCESS CARD
(DAFAC)
Region: V SerIal No.
Province: MASBATE BENEFICIARY'S COPY
Municipality: AROROY
Barangay PURO
Evacuation Center/Site
HEAD OF THE FAMILY
SURNAME FIRST NAME MIDDLE NAME M F AGE
Date of Birth Occupation Monthly Income
4Ps Beneficiary IP-Type of Ethnicity
Health
Family Members Relationship to Date of Birth Age Gender Educ Occupational Skills Status/ Remarks
Family (See Code)
Casuality
House & lot owner
Code A - Elderly Women B - PWD C.
House/room and lot renter With Children Below 5 D. Pregnant
E. Lactating
House owner & lot renter
House owner, rent free lot with owners' consent Partially Damaged
Housing Condtion:
House owner, rent free lot w/o consent of the owner Totally Damaged
Rent-free house & lot with owner's consent 01 - Dead 03- Missing
Health Condtion:
Rent-free house & lot w/o owner's consent 02- Injured 04-With Illness
CANDELARIA R. VIRTUCIO
Signature/Thumbmark of Family Head Name/Signature of Brgy. Captain
Date Registered Name/ Signature of C/MSWDO
FAMILY ASSISTANCE RECORD
Name of Family Assistance Provided Recipient's
Date Signature/Thumbmark
Member Kind/Type Qty. Cost Provider
