RBI Form B

INDIVIDUAL RECORD OF BARANGAY INHABITANT

REGION I V - A CITY D A S M A R I Ñ A S
PROVINCE C A V I T E BRGY. B U R O L - 1

I. PERSONAL INFORMATION
NAME
(Last) (First) (Middle) (Ext)
DATE OF BIRTH PLACE OF BIRTH
MM DD YYYY
SEX MALE CIVIL STATUS SINGLE WIDOW / ER
FEMALE MARRIED SEPARATED

CITIZENSHIP: F I L I P I N O

PROFESSION/OCCUPATION

RESIDENCE ADDRESS :
House Street Name

Subdivision Name/Zone/ Sitio/Purok

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

Date Accomplished Name/Signature of Person Accomplishing the Form

Attested by:

MR. ROQUE I. GALIT Left Right

Barangay Secretary Thumbmark Thumbmark

Household Number
Note: The Household No. shall be filled up by the Barangay Secretary
RBI Form B

INDIVIDUAL RECORD OF BARANGAY INHABITANT

REGION I V - A CITY D A S M A R I Ñ A S

PROVINCE C A V I T E BRGY. B U R O L - 1

I. PERSONAL INFORMATION
NAME
(Last) (First) (Middle) (Ext)
DATE OF BIRTH PLACE OF BIRTH
MM DD YYYY
SEX MALE CIVIL STATUS SINGLE WIDOW / ER
FEMALE MARRIED SEPARATED

CITIZENSHIP: F I L I P I N O

PROFESSION/OCCUPATION

RESIDENCE ADDRESS :
House Street Name

Subdivision Name/Zone/ Sitio/Purok

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

Date Accomplished Name/Signature of Person Accomplishing the Form

Attested by:

MR. ROQUE I. GALIT Left Right

Barangay Secretary Thumbmark Thumbmark

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