REVISED VERSION IMSU-11-2020

NCFRS ENROLLMENT FORM

NATIONAL COCONUT FARMERS’ REGISTRY SYSTEM (NCFRS)
Date :
REFERENCE /
CONTROL NO.:
New Existing m m d d y y y y

Write legibly and neatly (not in cursive handwriting) Items with * are mandatory fields and must not be left blank
PART I. PERSONAL INFORMATION

NAME OF FARMER* Lastname (LN) Firstname (FN) Middle Name (MN) Extension Name or Suffix (EN)
LN FN MN EN

ADDRESS* DATE OF BIRTH*: SEX*

___________________________ ___________________________ __________________________ M F
HOUSE / LOT / BLDG.NO. STREET / SITIO / SUBD. BARANGAY m m d d y y y y
PLACE OF
___________________________ __________________________ ___________________________
MUNICIPALITY / CITY PROVINCE REGION BIRTH ______________________
HIGHEST EDUCATIONAL ATTAINMENT* None
CIVIL STATUS* Single Married Widowed Separated
Elem. Level HS Level College Level Vocational
With Gov’t. ID?* Y N ID Type_______________ ID No.______ Elem. Grad HS Grad. College Grad. Postgraduate
CONTACT NUMBERS* 1.______________________________ 2 .______________________________ RELIGION* ____________________
Mother’s Maiden Name Lastname (LN) Firstname (FN) Middle Name (MN) Extension Name or Suffix (EN)
LN FN MN EN
Date of Birth of Spouse Works in Number of
Name/s of Legal Spouse/s, if Married: Lastname (LN) Firstname (FN) Middle Initial (MI) mm d d y y y y Coco Farm: Children
LN FN MI Y N _______
LN FN MI Y N _______
LN FN MI Y N _______
LN FN MI Y N _______

DATE OF BIRTH Works in Civil

CHILDREN: Use separate sheet if necessary. SEX (M/F) Coco Farm: Status:
mm d d y y y y
1. LN FN MI M F Y N _______
2. LN FN MI M F Y N _______
3. LN FN MI M F Y N _______
4. LN FN MI M F Y N _______
5. LN FN MI M F Y N _______
6. LN FN MI M F Y N _______
Person to Notify in
Case of Emergency: LN FN MI Contact No.: ___________________

HOUSEHOLD HEAD?* Yes No If No, Indicate Name of Household Head. Relationship:______________ No. of Household Members?_____
LN FN MN EN
Current Occupation/Profession aside from Coco Farming* __________________ Year Started in this Occu./Prof._____ Monthly Income _________

Beneficiary of Agrarian Reform* Yes No Since When (Indicate Year): _____________ PERSON WITH DISABILITY (PWD): Yes No
Beneficiary of any If yes, specify: _____________________________
Gov’t. Program?* Program 4Ps SAP Insurance Others_________
Member of an Indigenous Group? Yes No
Yes No Year/s Participated
If yes, specify: _____________________________
Beneficiary of any PCA Programs/Projects | Year Participated* Yes No
Intervention/s Seedlings Fertilizers Incentives Intercrops Livestock Equipment Training Others _____________
Year/s Participated

Membership in Coco Cooperative Farmers’ Assoc. Others _______________

Farmers Assoc/Coop?* Year started in
Yes No Coco Farming __________

NUMBER OF COCONUT FARM PARCEL OWNED, TENANTED, OR WORKED FOR?* (CHECK BOX/ES AND INDICATE NUMBER/S)
Owner Owner-Tiller Grower Tenant Tenant-Worker Worker-Laborer Others TOTAL PARCEL

NATIONAL COCONUT FARMERS’ REGISTRY SYSTEM (NCFRS)

REFERENCE / CONTROL NO.:
ENROLLMENT CLIENT’S COPY Date:
m m d d y y y y

LAST NAME FIRST NAME MIDDLE NAME SUFFIX

THIS FORM IS NOT FOR SALE
PART II. FARM PROFILE
Land- Owner Owner-Tiller Grower Tenant Tenant-Worker Worker-Laborer Others CHOICES
Holding
Parcel No.
Status* Farm Location*: Prov.:________________ Mun/City:__________________ Brgy:_________________ COCONUT TREES
Variety A
FOR OWNER or OWNER-TILLER | GROWER | TENANT or TENANT-WORKER1/ | OTHERS 1-Laguna Tall,
1/ For Tenant or Tenant-Worker with ABSENTEE OWNER only 2-Tagnanan Tall,
3-Tacunan Dwarf,
Land Ownership Absolute Coconut Intercrop Other Crop Idle Organic Certified* Y N 4-Catigan Dwarf,
Area (in Hectares)* 5-Makapuno
GAP Certified* Y N 6-PCA 15-1, 7-PCA 15-2,
Area Classification* Inland-Upland Inland-Flat Coastal-Upland Coastal-Flat 8-Others,specify
Planting Pattern B
NOTE: PUT ONLY THE EQUIVALENT NUMBER/S ON QUESTIONS WITH CHOICES. REFER TO VALUES ON RIGHT. 1-Triangular,
COCONUT TREES* 2-Square, 3-Irregular,
4-Triple Planting,
Variety A Year Planted Planting Pattern B Planting Distance C No. of Trees Ave.Nut/Tree/Year 5-Others,specify
Planting Distance C
1-8x8, 2-9x9, 3-10x10,
4-Irregular,
5-Others,specify
FARM INCOME TYPES: D
Coconut Products
1-Copra, 2-Whole Nut,
FARM INCOMES / EXPENSES* 3-Buko, 4-Others,specify
Quantity of Produce Unit (check one or specify) Unit Price Expenses (Specify Per Type) Food By-Products
Type D
per Hectare/Year Kg Pc Liter Head ______ (P) Type/s E Amount (P) 5-VCO, 6-Sugar, 7-Vinegar,
8-Tuba, 9-Others,specify
Non-Food By-Products
10-Husk, 11-Shell,
12-Others,specify
Intercrops
13-Coffee, 14-Cacao,
15-Corn, 16-Vegetables,
Types of Processing 17-Others,specify
Facilities: Dryer, Specify______________ Charcoal Kiln Decort. Machine Others, _____________ Other Crops
Distance of Farm to Market: ______kms. Coco Harvesting Cycle: Less than 45 days 45 days 60 days 90 days 18-Rice,
19-Others,specify
Others, specify: Livestock/Poultry
1 2 3 4 5 6 20-Carabao, 21-Cattle,
Percent F Husks 22-Pig, 23-Goat,
24-Chicken,
Utilization of G Shell 25-Others,specify
Coconut Parts: H
9 Water
Others, specify: EXPENSE TYPE: E
Whom and Nuts Buko Shell Copra Husks Intercrop 1-Farm Labor,
Where Products I 2-Marketing,
3-Farm Inputs,
are Sold? J 4-Others, specify
OWNERSHIP DOCUMENT*: HUSKS UTILIZATION: F
1-Fuel for Copra Making,
Certificate of Land Transfer Co-ownership CLOA Certificate of Title or Regular Title 2-Household Fuel,
Emancipation Patent Agricultural sales patent Certificate of Ancestral Domain Title 3-Handicraft,
Individual Certificate of Land Homestead patent Certificate of Ancestral Land Title 4-Ornamental,
Ownership Award (CLOA) 5-Farm Mulching,
Free Patent Tax Declaration 6-Wasted,
Collective CLOA Extrajudicial Partition Deed of Sale DAR ID 7-Others,specify
SHELL UTILIZATION: G
For TENANT or TENANT-WORKER only: Write the Name of Farm Owner . 1-Fuel for Copra Making,
For FARM WORKER-LABORER only: Write the Name of Owner or Tenant you are working for. 2-Household Fuel,
3-Handicraft,
NAME OF OWNER or TENANT*: Lastname (LN) Firstname (FN) Middle Name (MN) Extension Name or Suffix (EN) 4-Directly Sold,
LN FN MN EN 5-Charcoal Making,
6-Wasted,
Farm Location*: Prov.:__________________________ Mun/City:______________________ Brgy:___________________ 7-Others,specify
WATER UTILIZATION: H
FOR TENANT-WORKER | FARM WORKER-LABORER | OTHERS ONLY 1-Vinegar Making,
Others, specify: 2-Wasted,
Kind of Work: K 1 2 3 4 5 6 7 3-Others,specify
Monthly Income:* WHOM SOLD (A): I
Number of Days Working on Coconut Farm: In a Week __________ In a Month __________ In a Year __________ 1-Picked-up by Buyer,
2-Delivered to Buyer,
I hereby declare that all information indicated above are true and correct, and that they may be used by Philippine Coconut Authority for the
purposes of registration to the NCFRS and other legitimate interests of the Authority pursuant to its mandates. The personal information I provide
3-Direct to Processor,
in this form is given on my own volition. I understand and agree to the intended purpose of the information being given and authorize PCA or its 4-Direct to Exporter;
official agents to handle, process and store said information for the intended purpose subject to compliance with RA 10173 or the Data Privacy Act. 5-Others, specify
WHERE SOLD (B): J
1-Trader within the Brgy,
Date Printed Name of Applicant Signature of Applicant Thumbmark 2-Trader within the Mun,
VERIFIED TRUE AND CORRECT BY: 3-Trader in Neighboring City,
4-Others, specify
KIND OF WORK: K
1-Land Preparation,
SIGNATURE ABOVE PRINTED NAME / DATE SIGNATURE ABOVE PRINTED NAME / DATE SIGNATURE ABOVE PRINTED NAME / DATE SIGNATURE ABOVE PRINTED NAME / DATE 2-Planting,
BARANGAY CHAIRMAN CITY/MUNICIPAL AGRIC. OFFICE PCA AGRICULTURIST/DIV. CHIEF CAFC/MAFC CHAIRMAN 3-Cultivation,
The collection of personal information is for documentation, planning, reporting and processing purposes in availing agricultural related 4-Harvesting,
interventions. Processed data shall only be shared to partner agencies for planning, reporting and other use in accordance to the mandate of the 5-Farm Maintenance,
agency. This is in compliance with the Data Sharing Policy of PCA. You have the right to ask for a copy of your personal data that we hold about you 6-Copra Making,
as well as to ask for it to be corrected if you think it is wrong. To do so, please contact PCA Hotline: ________________________________________ 7-Dehusking,
Interviewed Encoded
6-Drying,
by: by:
7-Charcoal Making,
SIGNATURE ABOVE PRINTED NAME / DATE SIGNATURE ABOVE PRINTED NAME / DATE 8-Others,specify

VERIFIED TRUE AND CORRECT BY:

SIGNATURE ABOVE PRINTED NAME / DATE SIGNATURE ABOVE PRINTED NAME / DATE SIGNATURE ABOVE PRINTED NAME / DATE SIGNATURE ABOVE PRINTED NAME / DATE
BARANGAY CHAIRMAN CITY/MUNICIPAL AGRIC. OFFICE PCA AGRICULTURIST/DIV. CHIEF CAFC/MAFC CHAIRMAN
For more information, please contact: