CARPER LAD Form No.

31A
(Revised CARP-LAD Form No. 33A)
Republic of the Philippines
DEPARTMENT OF AGRARIAN REFORM
Region No. XIII-CARAGA
Province of SURIGAO DEL NORTE
Municipality of CLAVER

AMENDED MASTER LIST OF QUALIFIED AGRARIAN REFORM BENEFICIARIES (ARBs)

Landowner/s: (Write full names of all co-owners– Family Name, First Name, Middle Initial).
CLAUDIO B. MADELO, ET.AL.

Location Mnicipality,Barngay): DAYWAN, CLAVER OCT/TCT No. OCT 952 TD No. Total Area: 0.4265 has. Lot No. 180 Approved Survey No.: PSD-13-013319(AR) Crops Planted: COCONUTS

Name of Length of
Present Position/
Name of ARBs Spouse Tenure/Service Remarks
No. Address Status1 Designation2
(Last Name, First Name, Middle Initial) (Last Name, First Name, Middle Initial) (No. of Days)
1 MARIA SHEILA P. CAGATA TAYAGA, CLAVER SINGLE ACTUAL TILLER
2 LUCENA A. ACELO LADGARON, CLAVER WIDOW ACTUAL TILLER
3 ROSALINA S. CATONG TAYAGA, CLAVER WIDOW FARM WORKER
4 CERINO P. PARNADA LADGARON, CLAVER ARNULFA B. LIGAHE FARM WORKER
5 RICKY V. BAUGTO DAYWAN, CLAVER SINGLE FARM WORKER
6 ROGELIO S. LAMANILAO DAYWAN, CLAVER ESTERLITA B. BORRES FARM WORKER
XXNOTHING FOLLOWSXXX

Note: Put a big “X” in the row immediately after writing/typing/encoding the name of the last ARB in the list. Then put the words “NOTHING FOLLOWS”. Use additional sheet, if necessary

Prepared by: Reviewed by: Certified by: Approved by:

MARILYN S. LEGASPI GRECITA P. CALINAWAN ANGELITA L. BAHINGAWAN MARIA ELIZABETH L. DE GUZMAN
Senior Agrarian Reform Program Technologist OIC- Municipal Agrarian Reform Program Officer Barangay Agrarian Reform Council Chairperson Acting Provincial Agrarian Reform Officer II
(Signature Over Printed Name) (Signature Over Printed Name) or Authorized Representative (Signature over Printed Name)
(Signature Over Printed Name)

SUBSCRIBED and SWORN to before me, this ____ day of ________________, 20___ in _____________________, the certifying BARC Chairperson/Member having presented to me his/her competent proof of Identification ________________________ .

______________________________________
Administering Officer

1
Present Status (i.e., tenant, lessee, regular farmworker, seasonal farmworker, other farmworker, actual tillers or occupants of public lands, etc)
2
Position/Designation/Nature of Work (i.e., Laborer, Foreman, Supervisor, Kapatas, others, please specify, if applicable)
3 ForMasterlist of Individual ARBs, place N/A (not applicable) on space for BSC.
**If list consists of several pages, MARO, PARO, and BARC Chairperson shall affix initials on all pages and sign only the last page on appropriate space for signature

CARPER LAD Form No. 31A

 CARPER LAD Form No. 31
(Revised CARP-LAD Form No. 33A)
ADDITIONAL SHEET FOR THE MASTERLIST OF QUALIFIED BENEFICIARIES

Length of
Name of Present Position/
Name of ARBs Tenure/ Remarks
No. Address Spouse Status1 Designation2
(Last Name, First Name, Middle Initial) Service

Note: Put a big “X” in the row immediately after writing/typing/encoding the name of the last ARB in the list. Then put the words “NOTHING FOLLOWS”. Use additional sheet, if necessary

1 Present Status (i.e., tenant, lessee, regular farmworker, seasonal farmworker, other farmworker, actual tillers or occupants of public lands, etc)
2
Position/Designation/Nature of Work (i.e., Laborer, Foreman, Supervisor, Kapatas, others, please specify, if applicable)
3 ForMasterlist of Individual ARBs, place N/A (not applicable) on space for BSC.

CARPER LAD Form No. 31A