Annex “C”

Republic of the Philippines

Province of Cavite
City of Tagaytay

Barangay Iruhin West

May 2019
MONITORING OF SURRENDERERS

NAME OF SURRENDERER ADDRESS SEX DATE REFERRED TO DATE OF STATUS

SURRENDERED (CADAC,/MADAC/PNP, REFERRAL
NBI,ETC.)
1.
2. NONE DURING
THE PERIOD
3.
4.
5.
6.
7.
8.
9.
10.

*Status may include, but not limited to the following:

(a) Type of intervention – I,e. referred to rehabilitation center (RC), date of referral, name of RC counselling or other types of
intervensionS
(b) Progress surrenderer
(c) Other relevant information and dates
 Annex “B”

Republic of the Philippines

Province of Cavite
City of Tagaytay

Barangay Iruhin West

July 2019
PERSONAL INFORMATION OF VOLUNTARY SURRENDERERS
(Pursuant to Section 3(B) DDB Regulation N0. 4, Series of 2016)

NAME OF ADDRESS SEX CIVIL CONTACT RELIGIOUS REMARKS

STATUS NUMBER AFFILATION (Other Information)

1.
2. NONE DURING THE
PERIOD
3.
4.
5.
6.
7.
8.
9.
10

Prepared by; Noted by;

MARJORIE B. FRANCISCO HON. BENEDICTO A. RODRIGUEZ

Name and Signature of Duty Officer Name and Signature of BADAC Chairman