Name of Project: TUPAD OSEC-FMS Form No.

4
DOLE Regional Office: VI
Province: NEGROS OCCIDENTAL
Municipality: TALISAY CITY
Barangay: ZONE -4

LIST OF BENEFICIARIES

Name of Beneficiary Birthdate1 Address2 Interested for If Yes,

Exte Type of ID E-payment/Bank
Account No. (indicate Civil Dependent7 (Name of Beneficiary of Skills Training Indicate skills
No. nsio (e.g. SSS, Voter's ID Number Contact No. Type of Beneficiary3 Occupation4 Sex5 Age
Baran Distric the type of account and
Status 6
the Micro-insurance Holder) (Y - Yes training
First Name Middle Name Last Name n (YYYY/MM/DD City/Municipality Province ID) no. as applicable)

gay t N - No) needed9

Nam )
e
1 LEIZEL MORALES DE AGUAS 1984-10-04 4 TALISAY NEG.OCC. III UMID 01110582248-3 9185510471 UNDEREMPLOYED ON- LINE SELLER F S 36 BATCHEEVA AZUE

2 GEMMA SAPIO TEODORO 1982/06/12 4 TALISAY NEG. OCC. III BRGY. ID Z4-0178 9128165827 UNDEREMPLOYED NONE F M 38 GEZEL TEODORO

3 APRIL CAPATAR BAGAPORO 1986-04-19 4 TALISAY NEG. OCC. III PASSPORT P5066389B 9091791751 UNDEREMPLOYED VENDOR (Fruit) F M 35 ARABELLA FAYE VILLAREAL

4 ROTHEZA PABILA DE LA CRUZ 1986-04-28 4 TALISAY NEG. OCC. III BRGY. ID Z4-0134 9105151843 UNDEREMPLOYED FISH VENDOR

5 LILIBETH ORTIZ LIRA 1991-09-13 4 TALISAY NEG. OCC. III BRGY. ID Z4-0157 9203986016 UNDEREMPLOYED NONE F S 29 KYLA LIRA

6 JONNAH LYN LOMILLO SUANQUE 4 TALISAY NEG. OCC. III BRGY. ID Z4-0128 9319776708 UNDEREMPLOYED VENDOR (Food) F M 48 GALE GILSEN SUANQUE
1973-02-23

7 SHEILA ILUSTRESIMO ESCARLAN 1986-01-11 4 TALISAY NEG. OCC. III BRGY. ID Z4-0129 9631705251 UNDEREMPLOYED NONE F S 35 JOEMAR DE LAS SANTOS

8 LILYNETH TAVERA CONLU 1969-10-28 4 TALISAY NEG. OCC. III BRGY. ID ZA-0032 9197604481 UNDEREMPLOYED VENDOR F M 52 ARNEL CONLU SR.

9 GLENDA JOVER CONLU 1963-09-12 4 TALISAY NEG. OCC. III BRGY. ID Z4--0033 9197604481 UNDEREMPLOYED SARI-SARI STORE F M 57 DANILO CONLU

10 JASMIN LOMILLO DACULLO 1975-02-03 4 TALISAY NEG. OCC. III BRGY. ID Z4-0034 9384098800 UNDEREMPLOYED SARI SARI STORE F M 46 MARIANNE JOYCE DACULLO

11 MERCEDITA ZULUETA DIOSA 1961-04-12 4 TALISAY NEG. OCC. III BRGY. ID ZA-0035 9384098800 UNDEREMPLOYED AGOGO VENDOR F M 60 CONDRADO DIOSA

12 NILO PADIOS PENUELA0 1980-12-22 4 TALISAY NEG. OCC. III TIN ID 452-094-178 9454352299 UNDEREMPLOYED LABORER M M 40 LIZEL PENUELA

13 MARY LOY LUBAS LAMIG 1981-08-01 4 TALISAY NEG. OCC. III BRGY. ID Z4-0024 94895472206 UNDEREMPLOYED VENDOR (AGOGO) F M 40 ROMAR LAMIG

14 DAYNA OLIVEREZ VILLANUEVA 1968-01-01 4 TALISAY NEG. OCC. III BRGY. ID Z4-00138 9504509550 UNDEREMPLOYED VENDOR (FOODS) F M 53 KENJI VILLANUEVA

15 ARMA ESCAMOS DITCHON 1973-02-28 4 TALISAY NEG. OCC. III BRGY. ID Z4-0036 9515883589 UNDEREMPLOYED FISH VENDOR F
 I hereby certify that the above list of beneficiaries are displaced workers, underemployed or self-employed workers that have lost their livelihood or whose earnings were affected by the COVID-19 pandemic.

Further, I certify that they or any member of their families were verified to have not received cash assistance from DOF's Small Business Wage Subsidy Program and SSS Unemployment Benefit.

Prepared and Certified true and Correct by:

REMO D. PERSIA

Punong Barangay/ Mayor

Notes:
*Only the gray portion of this form should be submitted to concerned agencies, i.e DSWD for data matching/validation.
1 – Birthdate: Year/Month/Day (YYYY/MM/DD)
2 – Address: (Street No, Barangay, City/Municipality, Province, District)
3 –Type of Beneficiaries:
• Underemployed/Self-employed
• Minimum wage/below minimum wage earners that were displaced due to:
a. temporary suspension of business operations
b. calamity/crisis situation (please specify): COVID 19 pandemic, Earthquake, Typhoon (please specify), Volcanic eruption (please specify), Global/National financial
crisis, others
c. closure of company, retrenchment
• PWDs, Senior citizens, Former rebels, Former Violent Extremist Groups, Indigenous People

4 - Occupation - Transport workers, Vendors, Crop growers (please specify, i.e tobacco farmer), Homebased worker (please specify, i.e sewer), Fisherfolks, Livestock/Poultry Raiser, Small transport drivers,
Laborer (please specify), Barangay Tanod, Barangay Health Workers
• Others (please specify)

5 – Sex: F for female, M for Male

6 – Civil Status: S for single, M for married
7 – Dependent: Name of the Beneficiary of micro-insurance policy holder.
8 - Trainings: Agriculture crops production, Aquaculture, Automotive, Construction, Welding, Information and Communication Technology,Electrical and electronics, Furniture making, Garments and textiles, Food Processing, Cooking, Housekeeping, Tourism, Customer Services, Others (please specify)

Note: Statement of Informed Consent

I understand the purpose of this profiling activity. I voluntarily and willfully give my consent to be part of this undertaking. I certify that the information that I will give are true and correct and that any misrepresentation and falsification of information may void their application to TUPAD. I authorize
the use, processing and sharing of my personal data for the purpose that is intended for without prejudice to my rights stated in the Data Privacy Act of 2012.
Name of Project: TUPAD
DOLE Regional Office: VI
Province: NEGROS OCCIDENTAL
Municipality: TALISAY CITY
Barangay: ZONE -4

Birthdate1
Name of Beneficiary Address2
No. Extension City/Municipali
First Name Middle Name Last Name Barangay
Name (YYYY/MM/D ty
1 ERNESTO SALAVER LOMILLO JR. D)
1964-08-01 4 TALISAY
2 KIMBE VILLERA VILLASOR 2/17/2000 4 TALISAY
3 MINA ABALOS HECHANOVA 1964-06-11 4 TALISAY
4 MARIE MAY PISAYCO ABALOS 1990-05-06 4 TALISAY
5
6
7
8
9
10
11
12
13
14
15 ARMA ESCAMOS DITCHON 1973-02-28
 LIST OF BENEFICIARIES

Address2 Type of ID E-payment/Bank

Account No.
(e.g. SSS, Voter's ID Number Contact No. (indicate the type of Type of Beneficiary3
Province District ID)
account and no. as
applicable)

NEG. OCC. III BRGY. ID Z4-0151 9515670842 UNDEREMPLOYED

NEG. OCC. III BRGY. ID Z4-0153 9632181516 UNDEREMPLOYED
NEG. OCC. III BRGY. ID Z4-0155 9079507219 UNDEREMPLOYED
NEG. OCC. III BRGY. ID Z4-0158 9072453153 UNDEREMPLOYED
 OSEC-FMS Form No. 4

Interested If Yes,
for Skills Indicate
Civil Dependent7 (Name of Beneficiary of
Occupation4 Sex5 Age Training skills
Status6 the Micro-insurance Holder)
(Y - Yes training
LABORER M M 56 MA. LUZ HINOLAN N - No) needed9
LAUNDRY F S 21 MARK ORAY
NONE F M 56 RONA ABRICO
NONE F M 30 VINCENT LOMILLO
Name of Project: TUPAD
DOLE Regional Office: VI
Province: NEGROS OCCIDENTAL
Municipality: TALISAY CITY
Barangay: ZONE -4

Birthdate1
Name of Beneficiary Address2
No. Extension City/Municip
First Name Middle Name Last Name Barangay
Name (YYYY/MM/DD ality
1 JULIETA BINGUAN DIOSE )
1968-10-12 4 TALISAY
2 MA. VICTORIA MADRONES MAZO 6/10/1979 4 TALISAY
3 JOHN ERIC BLANCIA PALPAL 1999-06-09 4 TALISAY
4 MARK JOHN LOGARTE BELONIO 1983-09-21 4 TALISAY
5 JAN MARIE VILLARUEL TUPAS 1985-07-07 4 TALISAY
6 MA. SALOME BALANGKIG RIO 1979-05-03 4 TALISAY
7 JAYPEE BINGUAN MARTINEZ 1985-02-11 4 TALISAY
8 JEZREL MAGALLANES MAHINAY 1998-05-04 4 TALISAY
9 NOEL VALENZUELA BAGATELA 1961-07-04 4 TALISAY
10 AMIHAN CONLU MONDIGO 1977-02-09 4 TALISAY
11 RIZA DAGOY VILLANUEVA 1990-06-19 4 TALISAY
12 EVELYN GRANDIA LUCERO 1983-02-23 4 TALISAY
13 RUTHCEL PABILA DEL MUNDO 1983-02-25 4 TALISAY
14 MARILYN BINGUAN TOBESA 1970-12-04 4 TALISAY
15 CITADEL ESPAǸOLA ALCALA 1971-12-30 4 TALISAY

I hereby certify that the above list of beneficiaries are displaced workers, underemployed or self-employ

Further, I certify that they or any member of their families were verified to have not received cash assista

Prepared and Certified true and Correct by:

 LIST OF BENEFICIARIES

Address2 Type of ID E-payment/Bank

Account No. (indicate
(e.g. SSS, ID Number Contact No. the type of account and Type of Beneficiary3
Province District Voter's ID) no. as applicable)

NEG. OCC. III BRGY. ID Z4-0139 9103587278 UNDEREMPLOYED

NEG. OCC. III BRGY. ID Z4-0138 9484968465 UNDEREMPLOYED
NEG. OCC. III BRGY. ID Z4-0171 9060290694 UNDEREMPLOYED
NEG. OCC. III BRGY. ID Z4-0137 9519741177 UNDEREMPLOYED
NEG. OCC. III BRGY. ID Z4-0167 9217380710 UNDEREMPLOYED
NEG. OCC. III BRGY. ID Z4-0172 9519741177 UNDEREMPLOYED
NEG. OCC. III BRGY. ID Z4-0052 9104649097 UNDEREMPLOYED
NEG. OCC. III BRGY. ID Z4-0154 9458426103 UNDEREMPLOYED
NEG. OCC. III BRGY. ID Z4-0152 9096437442 UNDEREMPLOYED
NEG. OCC. III SSS ID 07-3410139-8 9464931622 UNDEREMPLOYED
NEG. OCC. III TIN ID 407-883-276 9108964187 UNDEREMPLOYED
NEG. OCC. III BRGY. ID Z4-0146 9511582800 UNDEREMPLOED
NEG. OCC. III BRGY. ID Z4-0148 9516083479 UNDEREMPLOYED
NEG. OCC. III BRGY. ID Z4-0149 9075714626 UNDEREMPLOYED
NEG. OCC. III BRGY. ID Z4-0147 9055568139 UNDEREMPLOYED

ployed or self-employed workers that have lost their livelihood or whose earnings were affected by the COVID-19 pandemi

received cash assistance from DOF's Small Business Wage Subsidy Program and SSS Unemployment Benefit.
 OSEC-FMS Form No. 4

Interested If Yes,
for Skills Indicate
Civil Dependent7 (Name of Beneficiary
Occupation4 Sex5 Age Training skills
Status6 of the Micro-insurance Holder)
(Y - Yes training
LABORER F M 52 RODEL DIOSO SR. N - No) needed9
LAUNDRY F S 41 DOMINGA MAZO
LABORER M S 21 LILIBETH PALPAL
VENDOR (FOOD) F S 37 JENETTE GENOLOS
ON LINE SELLER M S 35 VERGINIA TUPAS
VENDOR(FOOD) F F 41 ARNOLD NEGARE
BUTCHER M S 35 EMMA MARTINEZ
ON-LINE F S 23 DOLORES MAHINAY
BALUT VENDOR M M 59 FLORA BAGATELA
NONE F M 44 KEVIN MONDIGO
NONE F S 30 TEODORA VILLANUEVA
FISH VENDOR F M 38 REGIELYN LUCERO
NONE F M 38 JOEL DEL MUNDO
LABORER F M 50 ALVIN JAMES TOBESA
SARI-SARI STORE F S 49 GERDEL ALCALA

y the COVID-19 pandemic.

oyment Benefit.
Name of Project: TUPAD
DOLE Regional Office: VI
Province: NEGROS OCCIDENTAL
Municipality: TALISAY CITY
Barangay: ZONE -4

Birthdate1
Name of Beneficiary Address
No. Extension
First Name Middle Name Last Name Barangay
Name (YYYY/MM/D
1 HAIDE TANDO MANGAO D)
1960-05-28 4
2 MICHELLE ESTOR PIDO 3/6/1987 4
3 MICHELLE GERONIMO ELEGINO 1997-03-30 4
4 RIZA BALIDIONG CAǸETE 1996-12-06 4
5 CHARLES VINCENT OLIVEREZ OǸATE 2001-01-30 4
6 ROA PICNEA BAIAR 2000-09-21 4
7 TRISHIA ABEGAIL TUBESA CONLU 2001-02-20 4
8 ALTHEA MARIE LEGASPI TANDO 2000/09/154 4
9 JOHN RAY LOMILLO CONLU 1993-02-12 4
10 ABEGAIL STA. MARIA VILLAMIN 1994-01-17 4
11 MELODY MARTINEZ MELLIZA 1982-08-04 4
12 CHARLES MICHAEL LOMILLO CONLU 1997-02-12 4
13 CLEO TUBESA DE LA CRUZ 2001-11-17 4
14 REGINA GALLOPIN REMOLLENO 1981-10-31 4
15 MARY ROXANNE MABUTING GAMBOA 199/04/05 4

I hereby certify that the above list of beneficiaries are displaced workers, underemployed or self-em

Further, I certify that they or any member of their families were verified to have not received cash a

Prepared and Certified true and Correct by:

 LIST OF BENEFICIARIES

Address2 Type of ID E-payment/Bank

Account No.
City/Munic (e.g. SSS, ID Number Contact No. (indicate the type of
Province District Voter's ID)
account and no. as
ipality applicable)

TALISAY NEG.OCC. III BRGY. ID Z4-0017 9631961822

TALISAY NEG. OCC. III BRGY. ID Z4-0017 9128165827
TALISAY NEG. OCC. III BRGY. ID Z4-0069 9104266834
TALISAY NEG. OCC. III BRGY. ID Z4-0103 9319094814
TALISAY NEG. OCC. III BRGY. ID Z4-0133 9076507219
TALISAY NEG. OCC. III BRGY. ID Z4-0122 9300284813
TALISAY NEG. OCC. III BRGY. ID Z4-0123 9308775844
TALISAY NEG. OCC. III BRGY. ID Z4-0124 9317892606
TALISAY NEG. OCC. III BRGY. ID Z4-0125 9566955867
TALISAY NEG. OCC. III BRGY. ID Z4-0126 9197608706
TALISAY NEG. OCC. III BRGY. ID Z4-0127 9772515407
TALISAY NEG. OCC. III BRGY. ID Z4-0130 9511431721
TALISAY NEG. OCC. III BRGY. ID Z4-0131 9157521074
TALISAY NEG. OCC. III BRGY. ID Z4-0132 9630143638
TALISAY NEG. OCC. III TIN ID 46-609-115 9510202627

nderemployed or self-employed workers that have lost their livelihood or whose earnings were affected by the COVID-19 p

ave not received cash assistance from DOF's Small Business Wage Subsidy Program and SSS Unemployment Benefit.
 OSEC-FMS Form No. 4

Civil Dependent7 (Name of Beneficiary

Type of Beneficiary3 Occupation4 Sex5 Age
Status6 of the Micro-insurance Holder)
UNDEREMPLOYED STL AGENT F M 34 NATASHA PIDO
UNDEREMPLOYED NONE F M 38 GEZEL TEODORO
UNDEREMPLOYED NONE F S 24 CLARK ELEGINO
MINIMUM WAGE SALES LADY F S 26 MILAGROS CAǸETE
UNDEREMPLOYED NONE M S 20 MA. CHERRY OǸATE
UNDEREMPLOYED NONE F S 20 ROSELA BAJAR
UNDEREMPLOYED NONE F S 20 ARMANDO CONLU
UNDEREMPLOYED STUDENT F S 20 GIAN PARIS TANDO
UNDEREMPLOYED CONSTRUCTION M S 28 EVELYN CONLU
UNDEREMPLOYED NONE F S 27 LORNA VILLAMIN
UNDEREMPLOYED MANICURE F M 38 DANJELOU MELLIZA
UNDEREMPLOYED STUDENT M S 25 MARISSA CONLU
UNDEREMPLOYED STUDENT F S 20 CELSA DE LA CRUZ
UNDEREMPLOYED MANICURE F S 39 RIYANAH REMOLLENO
UNDEREMPLOYED NONE F S 22 JOHN MICHAEL DE GRACIA

s were affected by the COVID-19 pandemic.

and SSS Unemployment Benefit.

Interested for If Yes,
Skills Indicate
Training skills
(Y - Yes training
N - No) needed9