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KP Form-1
PHOTO
KASAMBAHAY REGISTRATION FORM
INSTRUCTIONS: ACOMPLISH IN TWO (2) COPIES KR NO. -
PUT CHECK ( ) IN THE APPROPRIATE BOXES (YYYY-5 Numbers. Ex. 2013-00001)

1. PERSONAL INFORMATION

___________________ __________________ ___________________

FIST NAME MIDDLE NAME LAST NAME

EMPLOYER’S ADDRESS: ___________________________________________________

(House No. / Street/Subdivision/Barangay/City or Municipality/Province)

HOME ADDRESS: ________________________________________________________

(House No. / Street/Subdivision/Barangay/City or Municipality/Province)

SEX: Male Female CIVIL STATUS: Single Married Widow/er Separated

AGE: _______ DATE OF BIRTH: _______ (MM/DD/YYYY) CONTACT NO: ___________

SSS No. _______________: PAG-IBIG No. ___________: Philhealth No. ____________

_______________________________________________________________________

2. FAMILY INFORMATION

NAME OF SPOUSE: _______________________________ CONTACT NO. ______________

FATHER’S NAME: __________________________ ADDRESS: _______________________
MOTHER’S NAME: _________________________ ADDRESS: _______________________
IN CASE OF EMERGENCY, CONTACT PERSON: _____________ CONTACT NO. ____________

3. EDUCATIONAL INFORMATION
Highest Educational Attainment

Elementary Undergraduate High School Graduate Vocational

Elementary Graduate College Undergraduate
High School Undergraduate College Graduate

4. WORK INFORMATION

Monthly Salary: Php ____________

Nature of Work: General Househelp Yaya
Cook Gardener
Laundry Person Others (Pls.Specify)

Employment Arrangement Live-in Live-out

Nature of Employer: ___________________

5. ATTACHED DOCUMENT

Kontrata sa Paglilingkod sa Tahanan

I hereby certify that the above information are true and correct and may be used
for any legal purpose. I further certify that may signature appearing herein is genuine
and authentic.

_____________________
Signature of Kasambahay
Received by: _________________
Kasambahay Desk Officer

Date: ______________________