KASAMBAHAY MASTERLIST

Barangay ______________
Province of Southern Leyte
Municipality of San Francisco

Registra Home SEX AGE CIVIL Educational Nature of Work Employment Salary Membership Name of Employer’s
tion Address STAT Attainment 1. Gen. Arrangement 1. P 1,500.00 (Write Y for Yes, and N for Employer Complete
Control US 1.Elem. school Househelper 1. Live-in 2. 2,000.00 No) Address
Name of Kasambahay
Number 2. Elem. Grad 2. Yaya 2. Live-out 3. 2,500.00
3. H. S Grad 3. Cook 4. Above
Last Name First Name Middle Name SSS PAG-IBIG Phil-Health
4. H. S 4.Gardener 2,500 but
Undergrad 5. Laundry less than
5. Coll, Person 5,000
Undergrad 6. Other 5. 5,000 and
6. Coll, Grad above
7. Vocational

Prepared by:
_____________________________________
Kasambahay Desk Officer

Date: _________________________________