Name of Purok: _____________________ Name of Barangay:______________
Total Land Area: _____________________ Total Population: ____________________ Male: ___________ Female: ___________ Population Growth Rate No. of Household: ___________ No. of Families: ___________ Total No. of Youth (15-21): Total No. of Married:_____________ Male: ___________ Total No. of Live-in Partner:________ Female: ___________ Total No. of Separated:___________ Total No. of Senior Citizen: Total No. of Widows:_____________ Male: ___________ Total No. of Widowers:____________ Female: ___________ Total No. of Solo Parent: Male: ___________ Female: ___________ Total No. of PWD: Male: ___________ Female: ___________ Total No. of Household: With Comfort Room: ___________ Without Comfort Room: ___________ Total No. of House Made of: Concrete: ___________ Semi-Concrete: ___________ Light Materials: ___________ Total No. of Household: Total No. of Lot: Owned: ___________ Owned:_______ Rented: ___________ Rented:_______ Government Owned: ___________ Government Owned:_______