Republic of the Philippines

City Government of Davao

City Agriculturist's Office
Agricultural and Biosystems Engineering Division

Date: ____________________

PRE-VALIDATION AND PRE-ASSESSMENT FORM

(Rainwater Catchment, Farm Mechanization and Irrigation Support )

I. General Project Profile

Proposed Project Name:

Project Location (Purok, Barangay, Municipality, Province):

Specific Project Type:

II. Beneficiary Profile

Name of Organization/Farmer:

Office Address (Purok, Barangay, Municipality, Province):

Total Number of Members : ________

Male : ________ Land Owners : ________ IP : ________
Female : ________ Tenants : ________ Non-IP : ________
Eligibility and Registration: Year Registered : ________________ (attach Certificate of Registration)
SEC CDA DOLE
Others: ___________________
CSO Accredited: YES NO
Remarks:

III. Production Area

Commodity (Major Crops) Physical Area (ha.) Yield (tons/ha) Potential Area (ha.)

Remarks:

IV. Project Site Profile (c/o RAED)

Proposed Projects Site Coordinates
N: E:
Attach google map photo with landmarks for reference, geo----tagged photo of the proposed site for the facility, service area, etc.

Topography:
Available of Land Site for the Project: YES: ______ NO: ______

______ Flat Terrain ______ Rolling Terrain ______ Mountainous

______ Swampy ______ River side ______ Valley

Proof of Ownership: Land Title: ______ Deed of Donation: ______

NCIP: ___________ Others, Specify: ______
Remarks:

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Site vulnerability, if applicable
Distance to the Production Area (km): Coordinates:
Road Connection: Type: Existing & Gravel Road
Barangay Municipal PCCP Road
National Provincial Asphalt

Distance to the Production Area (km): Coordinates:

Road Connection: Type: Existing & Gravel Road
Barangay Municipal PCCP Road
National Provincial Asphalt

Water Supply: With Provider:

Without

Power Supply: Single - Phase Without

Three - Phase Provider:

Existing similar facilities near the proposed area (if any):

Government Intervention Government Intervention
Name: Name:
Location: Location:
Distance to the proposed site (km): ___________ Distance to the proposed site (km): ___________

Overall assessment:

Beneficiary:
Signature over Printed Name Signature over Printed Name Signature over Printed Name
Contact No.:
Designation:

Validated by:
Signature over Printed Name Signature over Printed Name Signature over Printed Name
Designation:

Checked: Noted:

ENGR. GILBERT V. IGLESIAS ENGR. ANTHONY ROY. B. CARIÑO

Section Chief, PPM Chief, ABE Division

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