PANGKABUHAYANG QC

APPLICATION FORM

O-52822
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QCITIZEN ID NO.:
CATEGORY:
Displaced/Resigned/Reduced Salary Employees
Microentrepreneurs/Vendors
00700000710767
PWD
Unemployed solo parent
Laid-off OFW
Graduates of the QC Anti Drug Abuse Advisory Council (QCADAAC)
Indigent Residents of Quezon City
BUONG PANGALAN
MR./MS. ROWENA FERRER LAPSO
TITLE/PREFIX FIRSTNAME MIDDLENAME LASTNAME SUFFIX
URI NG NEGOSYO:
Food (carinderia/restaurant/stall)
Logistics (delivery/transportation)
Sari-Sari Store
Retail/Online Selling (clothes/accessories/products/etc.)
Others, please specify:
Kasarian: Civil Status: Petsa ng Kapanganakan (mm/dd/yyyy) Edad
Lalaki Single
Babae Married
Widowed 04/20/1978 44
Separated
Divorced
Tirahan
AREA 5 CORREGIDOR BAGONG SILANGAN DISTRICT 2
House/BuildingNo./Room&FloorNo./BuildingName StreetName Barangay District
QUEZON CITY METRO MANILA NCR 1119
City/Municipality Province Region ZipCode
PANINIRAHAN: BUONG PANGALAN NG MGA KASAMA SA BAHAY:
Nangungupahan 1. LAPSO JR., ROQUE LOZANO
Sariling Bahay 2. LAPSO, MARY JOY FERRER
3. LAPSO, JOSEPH FERRER
Nakikitira sa magulang o kamag-anak
4. LAPSO, JOSHUA FERRER
5. LAPSO, MARICHUY FERRER
CONTACT DETAILS:
Telephone Number Mobile Number Email Address
0948 284 8181 ROWENAFERRERLAPSO@GMAIL.COM
(area code) (landline no.)

I hereby declare and certify that I am the data subject and that I voluntary provided the Quezon City Government the
abovementioned information or data, which are true and correct to my knowledge, and that I have complied with all laws and
regulations governing the establishment, maintenance and operation of my business.

I hereby further declare that I authorize or consent to the collection, recording, organization, storage, use and processing
of the data or information herein provided for the purpose of establishing a databank which shall be a source of all
information necessary for project monitoring, research and policy studies and informal dissemination campaigns as part of
the Pangkabuhayang QC program and mandated by RA 10173 - Data Privacy Act of 2012.

ROWENA FERRER LAPSO

PRINTED NAME AND SIGNATURE DATE

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 PANGKABUHAYANG QC
APPLICATION FORM

Complete Name

MR./MS. ROWENA FERRER LAPSO

TITLE/PREFIX FIRSTNAME MIDDLENAME LASTNAME SUFFIX

1. Ano ang dahilan ng iyong pagsali sa programang Pangkabuhayang QC?

Magtayo ng maliit na negosyo

Dagdag puhunan
Other, please specify:

2. Ikaw ba ay naging benepisyaryo ng programang PANGKABUHAYANG QC PHASE 1?

Oo
Hindi

3. Ikaw ba ay may kamag-anak o kasama sa bahay na naging benepisyaryo ng PANGKABUHAYANG QC PHASE 1?

Oo
Hindi

4. Ikaw ba ay isang kawani ng Lungsod Quezon o ng Barangay?

Oo
Pangalan ng opisina o barangay:
Posisyon:
Hindi

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 MUNGKAHING PLANONG PANGNEGOSYO

I. PANGKALAHATANG IMPORMASYON (GENERAL INFORMATION)

A. Buong Pangalan ng Aplikante:

ROWENA FERRER LAPSO

B. Tirahan: AREA 5 CORREGIDOR, BAGONG SILANGAN, DISTRICT

2, 1119 QUEZON CITY, METRO MANILA, NCR
C. Edad:
44

D. Kasarian
Female

II. LAYUNIN (GOAL)

A. Ano ang iyong layunin sa pagtatag ng negosyo?

LAYUNIN KO PO NA PALAGUIN ANG AKING MUNTING TINDAHAN UPANG MAKATULONG SA AKING ASAWA UPANG MATUSTUSAN ANG P

III. MGA IMPORMASYON SA NEGOSYO (BUSINESS INFORMATION)

1. Bilang ng mga empleyado:

(Ilagay na "0" kung wala)
2. Lokasyon o address ng itatayong
negosyo o kasalukuyang negosyo:
0
AREA 5 CORREGIDOR, BAGONG SILANGAN, DISTRICT
2, 1119 QUEZON CITY, METRO MANILA, NCR
Food (carinderia/restaurant/stall)

3. Kategorya ng itatayong negosyo o Logistics (delivery/transportation)

kasalukuyang negosyo: Sari-Sari Store
Retail/Online Selling (clothes/accessories/products/etc.)
Others, please specify:

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IV. MGA KABAHAGI NG NEGOSYO (PARTS OF BUSINESS)

1. Listahan ng mga produkto at kagamitan na kailangan sa iyong negosyo:

BILANG UNIT HALAGA NG KABUUANG

(piraso) URI/TYPE
(pcs, kilo, box) BAWAT ISA HALAGA
3 150KLS RICE 1,940.00 5,820.00

5 KL HOTDOGS 135.00 675.00

5 KL TOCINO 210.00 1,050.00

5 KL SIOMAI 135.00 675.00

5 KL LONGANISA 198.00 990.00

50 PCS SARDINES 21.00 1,050.00

24 LITER DISHWASHING
32.00 768.00
LIQUID
10 1.5 LITER COKE 60.00 600.00

12 DOZEN COFFEE 114.00 1,368.00

50 PANCIT
PCS 13.75 687.50
CANTOON
100 PCS NOODDLES 8.50 850.00
5 BOX JUICE 92.00 460.00

10 PACKS BISCUITS 65.00 650.00

10 DOZEN SHAMPOO 65.00 650.00

5 PACKS DIAPER 182.00 910.00

10 DOZEN DETERGENT
67.00 670.00
POWDER
3 DOZEN BODY SOAP 192.00 576.00

TOTAL: 18,449.50

Pangalan ng Negosyo:

Uri ng Negosyo:

BUONG PANGALAN: LAGDA:

ROWENA FERRER LAPSO

CONTACT DETAILS:

VALIDATOR (SBCDPO Staff):

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V. MGA KINAKAILANGANG DOKUMENTO (LIST OF REQUIREMENTS)

Microentrepreneurs/Vendors

• Approved QCitizen ID
• Updated Barangay Business Clearance /Barangay Business Permit issued at least 2 weeks before application) or latest
Hawkers Permit /MDAD Registration for Market Vendors
• Attach pictures of existing business (inside and outside with owner)
• Pangkabuhayang QC Certificate signed and dry sealed by the Barangay
• Completed Application Form and Business Plan

VI. MGA DETALYE NG INTERVIEW (INTERVIEW DETAILS)

Appointment ID: 184061

Reference Number: IA121-0184061

Name: Rowena Ferrer Lapso

Email:

Phone: 09482848181

Appointment Date: August 4, 2022

Appointment scheduled to start at:14:00 PM

Appointment scheduled to end at: 15:00 PM

Appointment duration: 1 hour

Department: Pangkabuhayang QC

Appointment Type: Interview Appointment

DISTRICT 5 ACTION OFFICE- Novaliches District Center, Jordan Plains, Brgy Santa M
Branch:

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