CNA Form rev 1.

9_29Sept20_10:30AM

MEMBER-BENEFICIARY PROFILE

_________________________________________________________
NAME OF COMMUNITY ASSOCIATION

____________________________________________________
Name of Member-Beneficiary

1.23 Hanapbuhay ng Member-Beneficiary (MB) at miyembro ng kanyang pamilya na kasalukuyang kasama (1 of 2)

1.23a 1.23b 1.23c 1.23d 1.23e 1.23f 1.23g 1.23h 1.23i 1.23j 1.23k 1.23l 1.23m
Pangalan ng Miyembro ng Pamilya CMP Relasyon Kasarian Miyembro Kaara Kasalukuyan Antas o Miyembro Kakayahan PWD Email Address Contact No. (CP/ L
(LAST NAME/FIRST NAME/MIDDLE NAME/EXT) Applicant (w/ Code) (w/ Code) ng wan bang nag- grado sa (Financing (Skills) (Code) Landline) N
L
N (w/ Code) LGBTQIA+ at aaral? pag-aaral Institution) (w/ Code)
Note: Unahin ang MB respondent sa listahan. (w/ Code) Edad (w/ Code) (Refer to (Refer to
Codes in Codes in 1 2 3
1.14a) 1.18)
1 1

2 2

3 3

4 4

5 5

6 6

7 7

8 8

CODE CODE CODE CODE

1.23c Relasyon 1.23k PWD 1.23j Kakayahan (Skills) (Multiple Response – up to three)
1.23b, 1.23e, 1.23g
1 – Oo 2- Hindi 1 – Wife / Husband (Asawa) 7 – Father / Mother (Ama/Ina 1 – Physical / orthopaedic disability (May 1 – Pagkakarpintero 7 – Pag-eelektrisito 13 – Pag-aayos ng buhok
2 – Partner (Kinakasama) 8 – Other Relative Pisikal na kapansanan) 2 – Pagmamason 8 – Pagmamaneho 14 – Pananahi
1.23d Kasarian 3- Son / Daughter (Anak) (Ibang Kamag-anak) 2 – Hearing impairment (Bingi) 3 – Pagtutubero 9 – Pagbibigay ng serbisyong pang-seguridad 15 – Paggawa ng handicraft
1 – Babae 4 – Brother / Sister (Kapatid) 3 – Speech impairment (Pipi) 4 – Paglalapat ng Tiles 10 – Pagpipintura 16 – Housekeeping
2 – Lalaki 5 – Son-in-law / Daughter-in-law (Manugang) 4 – Visual impairment (Malabo ang mata o 5 – Pagwe-welding 11 – Pagkukumpuni ng mga kagamitang pang-teknolohiya 17 – Food processing
6 – Grandson / Granddaughter (Apo) Bulag) 6 – Pagme-mekaniko 12 – Pagluluto 18 – Wala
5 – Iba pa (Tukuyin) ___________ 19 – Iba pa
 CNA Form rev 1.9_29Sept20_10:30AM

MEMBER-BENEFICIARY PROFILE

_________________________________________________________
NAME OF COMMUNITY ASSOCIATION

_______________________________________________
Name of Member Beneficiary

1.23 Hanapbuhay ng Member-Beneficiary (MB) at miyembro ng kanyang pamilya na kasalukuyang kasama (2 of 2)

1.23n 1.23o 1.23p 1.23q 1.23r 1.23s 1.23t 1.23u 1.23v 1.23w
Pensyon kada Padalang Pinansyal na Pangunahing Hanapbuhay o Kita Kita Pangalawang Hanapbuhay o Kita Kita Kabuuang kita ng miyembro
L buwan Remittance kada suporta galing sa pinagkakakitaan (sa isang (sa isang pinagkakakitaan (sa isang (sa isang (Note: To be accomplished only L
N buwan galing sa ibang tao araw) buwan) (kung meron) araw) buwan) by the INTERVIEWER) N
kapamilya

1 1

2 2

3 3

4 4

5 5

6 6

7 7

8 8

REMARKS:________________________________________________________________________________________________________________________________
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