Instructions: Please supply the required information below by filling-in the blanks and ticking appropriate information in the

selections. Date of Submission: _________________

FARM MACHINERY UTILIZATION REPORT AND FEEDBACK FORM
Name of FCA : _____________________________________________________________________________ Address: ____________________________________________________________________
Contact Person: __________________________________________________________________________ Contact Number: __________________________________________________________
st nd rd
Cropping Period: 1 cropping 2 cropping 3 cropping Inclusive Months: _______________ to ________________ Year: ___________
Type of Farm Operation: Land Preparation and Plant Establishment Harvesting and Threshing
Present Buying Price of Palay in Your Area (Php): Fresh (Sariwa) ___________ Dry (Tuyo) _____________
Status of Machine Machinery Utilization Information Financial Information
Total no. of Total Area
Operational = (being used Farmers Availed Serviced
Rate of
Date of for its intended purpose) the Service (Kabuuang Available Funds
Service Fee Operating
Delivery Non-Operational = (not (Bilang ng hektaryang (including
Farm Machinery being used due to technical (Php) Gross Income Expenses
of kliyenteng naserbisyuhan) collectibles)
problems/ for repair) (Gastos)
Machine Functional = (ready for use naserbisyuhan) (ha) (a-b)
(a) (b)
but presently idle due to Non- Non- Non-
organizational problems or Member Member Member Collected Collectibles
Member Member Member Total
other issues) (Nagbayad) (Utang)
1.
2.
3.
4.
5.

Suggested Solutions/ Other Comments/

Organization and Management Issues
Low acceptability of
machine/ lack of awareness
Technical Issues
Frequent breakdown of
machine
Financial Issues
Unpaid collectibles
Problems Encountered (if there’s any)
Recommendations Suggestions
The management Others (pls specify)
Conflict among officers/ members
team lacks training _________________________
Non-compatibility of Others (pls specify)
High maintenance cost
of machine machine in the area _________________________
Others (pls specify)
Lack of operating Poor management
capital of funds _________________________

Other Problems Encountered

___________________________________________________________________________________________________________________________________________
Instructions: Please supply the required information below by filling-in the blanks and ticking appropriate information in the selections. Date of Submission: _________________

LIST OF FARMER CLIENTS

Farm Machinery: ________________________________

Address/ Location of Category Date of farm machinery Area Serviced Operating hours of farm
Client’s Farm service provided (ha) operation Amount Paid
Name of Farmer Client
(Lokasyon ng bukid ng Non- (petsa ng pagseserbisyo (bilang ng oras ng pagseserbisyo) (Php)
kliyente) Member * If Applicable
member ng makinarya) *If applicable
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
Prepared by: ________________________________ / _________________________ Reviewed/ Approved by: _____________________________________
Name and Signature Position or Designation Name and Signature of Chairman/
Instructions: Please supply the required information below by filling-in the blanks and ticking appropriate information in the selections. President
Date of Submission: _________________
Disclaimer: The contents of this form will be used solely for monitoring purposes of PHilMech and will be treated with utmost confidentiality.
This form is for enrollment to PHilMech-IMS.
 CASH FLOW STATEMENT OF FARM MACHINERY OPERATION PER CROPPING
Name of FCA : _____________________________________________________________________________ Address: _____________________________________________________________________
Contact Person: __________________________________________________________________________ Contact Number: __________________________________________________________

Cropping Period: 1st cropping 2nd cropping 3rd cropping Inclusive Months: _____________ to _____________ Year: ___________

Machinery 1: Machinery 2: Machinery 3: Machinery 4: Machinery 5:

________________________ _________________________ ______________________ _____________________ ____________________

Operating Cash-Beginning (a) Php___________________ Php___________________ Php__________________ Php________________ Php_______________

Cash Inflows (INCOME)
Total Service Fee Collected ________________ ________________ ________________ ________________ _______________
Other income ________________ ________________ ________________ ________________ _______________
Total Cash Inflows (b) ________________ ________________ ________________ ________________ _______________
Total Source of Cash (c) = a+b _____________________ _____________________ ____________________ ____________________ ___________________
Cash Outflows (EXPENSES)
Fuel expense (diesel, etc.) _______________ _______________ _______________ _______________ _______________
Labor Cost/ Honorarium _______________ _______________ _______________ _______________ _______________
Repair and Maintenance _______________ _______________ _______________ _______________ _______________
Other expenses _______________ _______________ _______________ _______________ _______________
Total Cash Outflows (d) _______________ _______________ _______________ _______________ _______________
Net Cash Flow per machinery (e) = c-d Php___________________ Php___________________ Php__________________ Php_________________ Php________________

Prepared by: ________________________________ / _________________________ Reviewed/ Approved by: _____________________________________

Name and Signature Position or Designation Name and Signature of Chairman/ President

Disclaimer: The contents of this form will be used solely for monitoring purposes of PHilMech and will be treated with utmost confidentiality.
This form is for enrollment to PHilMech-IMS.