10/13/21, 12:43 PM TEST ESMF 3B: Individual Actual Occupant Environmental & Social Performance (IO-ESP) Assessment

TEST ESMF 3B: Individual Actual Occupant Environmental &

Social Performance (IO-ESP) Assessment
To be accomplished by the FVT Team Leader, ESS Staff, and ESS Documenter (COS), verified by the Provincial ESS Coordinator
(Organic), and approved by the Provincial Agrarian Reform Program Officer (Organic)

Collective CLOA Sequence Number

OCT/TCT Number

Collective CLOA Number

Collective CLOA Date of Registration (mm/dd/yyyy)

Actual Occupant Profile

First Name

Middle Name

Last Name

Upload a Photo/Selfie with the Actual Occupant

Click here to upload file. (< 10MB)

Gender

Male

Female

Date of Birth (mm/dd/yyyy)

Lot # of the actual area of tillage/cultivation (based on the Approved Subdivision Plan if available)

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Actual area of tillage/cultivation (in square meters)

Is the Actual Occupant member of any ARB Organization?

Yes

No

If yes please specify ARB Organization/s (DAR Assisted)

Are there support services from DAR currently being availed or have been availed by the Actual Occupant?

Yes

No

Select the support service/s availed

Capacity Development

Credit/Microfinance Assistance

Farm Tools/Equipment

Farmer Business School

Others

Please specify Capacity Development

Please specify Credit/Microfinance Assistance

Please specify Farm Tools/Equipment

Please specify Farmer Business School

Please specify

Is the Actual Occupant member of any ICC/IP Community?

Yes

No

Prepare IPPF Attachments.

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Is there an issue of overlap in the actual area of tillage/cultivation?

Yes

No

May require RPF1A Attachment if needed.

Tenurial Status of Actual Occupant

Voluntary

HA - Heir of ARB

BA - Buyer from ARB

MA - Mortgage from ARB

DA - Donee from ARB

OC - Occupant Due to Incapacity of the ARB

OW - Occupant Due to Waiver of Rights by the ARB

OA - Occupant Due to Abandonment of the ARB

OP - Informal Occupant with Permission from ARB

Others

Please specify (Voluntary)

Involuntary
May require RPF1B Attachments if needed

ON - Occupant Due to Non-Installation of the ARB

WP - Informal Occupant without Permission from ARB (Squatter)

Others

Please specify (Involuntary)

Actual Occupant Additional Information

Educational Attainment

Elementary

Highschool

Post Secondary

College

Post Graduate

None

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Civil Status

Single

Married (Legally married)

Separated

Widowed

Common-Law Partner (Legally capacitated to marry pursuant to the Family Code)

Total Number of Children (Single, Separated, Widowed)

» Children Information (Single, Separated, Widowed)

Are any of the children involved in farming activities?

Yes

No

Please specify

Are any of the children engaged in off-farm/non farm livelihood activities?

Yes

No

Please specify

» Spouse Information (Legally Married)

First Name

Middle Name

Last Name

Gender

Male

Female

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Educational Attainment

Elementary

Highschool

Post Secondary

College

Post Graduate

None

Is the spouse actually tilling the same Collective CLOA parcel?

Yes

No

Is the spouse engaged in off-farm/non farm activities?

Yes

No

Please specify

Total Number of Children (Spouse)

» » Children Information (Spouse)

Are any of the children involved in farming activities?

Yes

No

Please specify

Are any of the children engaged in off-farm/non farm livelihood activities?

Yes

No

Please specify

» For Muslim and other Indigenous Communities Allowing Multiple Marriage

1
First Name

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10/13/21, 12:43 PM TEST ESMF 3B: Individual Actual Occupant Environmental &amp; Social Performance (IO-ESP) Assessment

Middle Name

Last Name

Gender

Male

Female

Is the spouse actually tilling the same Collective CLOA parcel?

Yes

No

Is the spouse engaged in off-farm/non farm activities?

Yes

No

Please specify

Total Number of Children (Spouse)

» » Children Information

Are any of the children involved in farming activities?

Yes

No

Please specify

Are any of the children engaged in off-farm/non farm livelihood activities?

Yes

No

Please specify

» Common-Law Partner Information (Legally capacitated to marry pursuant to the Family Code)

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First Name

Middle Name

Last Name

Gender

Male

Female

Educational Attainment

Elementary

Highschool

Post Secondary

College

Post Graduate

None

Is the common-law partner actually tilling the same Collective CLOA parcel?

Yes

No

Is the common-law partner engaged in off-farm/non farm activities?

Yes

No

Please specify

Total Number of Children (Common Law Partner)

» Children Information (Common Law Partner)

Are any of the children involved in farming activities?

Yes

No

Please specify

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Are any of the children engaged in off-farm/non farm livelihood activities?

Yes

No

Please specify

Actual Occupant Household

Is the Actual Occupant the head of the Household?

Yes

No

Total Number of Household Members

Are there extended families living within the household?

Yes

No

Please specify affinity

Number of individuals

Are there nursing mothers in the household?

Yes

No

How many?

Are there any senior citizens in the household?

Yes

No

How many?

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Are there any single parent in the household?

Yes

No

How many?

Is there a PWD in the household?

Yes

No

How many?

Type of disability

Is there anyone with lingering health condition/illness?

Yes

No

How many?

Type of illness/es

Location of Home

Within the actual tillage/cultivation

Outside the actual tillage/cultivation

Please specify the address

Indicate the size and describe the materials of your house

Example: 2 storey, cement house, 45 sqm

Source of power

Source of water

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Prepared by:
Field Validation Team ESS Staff or ESS Documenter (COS)

Upload a copy of your e-signature

Click here to upload file. (< 10MB)

Upload a photo of your Official DAR ID

Click here to upload file. (< 10MB)

Reviewed by:
Field Validation Team Leader (COS)

Upload a copy of your e-signature

Click here to upload file. (< 10MB)

Upload a photo of your Official DAR ID

Click here to upload file. (< 10MB)

Verified by:
Provincial ESS Coordinator (Organic)

Upload a copy of your e-signature

Click here to upload file. (< 10MB)

Upload a photo of your Official DAR ID

Click here to upload file. (< 10MB)

Approved By:
Provincial Agrarian Reform Program Officer

Upload a copy of your e-signature

Click here to upload file. (< 10MB)

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Upload a photo of your Official DAR ID

Click here to upload file. (< 10MB)

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