QR CODE

Name of Accommodation Establishment:

___MARTHE LANCE BEACH RESORT_ Date of Reservation: nov, 30 2021
Number of Reserved Room/s / Cottage/s: __________________ Event/Activity: family bonding
Address: ___CATABLINGAN, GEN. NAKAR, QUEZON Contact No.:09311331100
Contact No.: _09512975346_________________________________________ I.D. Presented: vaccine card
Type of vehicle: enova, adventure,motor

Email Address and/or

Place of Residence Remarks: (Specify Daytime Overnight
Contact Number
Municipality and
Reserved Sex Duration
Province, or Country
of stay
No. Date Name of Visitor Age Philippines of Residence) Time Time Time Time
Foreign
In Out In Out
Country
This Other
Male Female Municipality Municipality

1 felix c. repeles 52 M R NR Fo marikina 09311331100

2 lailanie p. repeles 40 F R NR Fo marikina

3 lanxel joseph p. 19 M R NR Fo marikina 09462004838

repeles
4 glaiza marie p. 17 F R NR Fo marikina
repeles
5 andrie p. repeles 10 M R NR Fo marikina
6 andrew p. repeles 10 M R NR Fo marikina

7 melchie repeles 48 M R NR Fo marikina 09566805411

 8 irene repeles 45 F R NR Fo marikina 09995119821
9 karl miguel repeles 17 M R NR Fo marikina 09655160099

10 mel angelo repeles 18 M R NR Fo marikina

11 myrna san jose 71 F R NR Fo marikina

12 M / F R NR Fo
13 M / F R NR Fo

14 M / F R NR Fo
15 M / F R NR Fo

16 M / F R NR Fo
17 M / F R NR Fo

18 M / F R NR Fo
19 M / F R NR Fo

20 M / F R NR Fo

Resident of this province

**NR Non-Resident of this province
***Fo Foreign/Non-Filipino Citizen