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Republic of the Philippines

Province of Iloilo
Municipality of Santa Barbara
Barangay:___________________________
PUBLIC EMPLOYMENT SERVICE OFFICE

REGISTRY FORM FOR PERSONS WITH DISABILITY


Name of Civil Educational Employment Status Disabilty
No. Age Sex Occupation Contact No. Remarks
PWD Member Status Attainment Employed Unemployed Type Causes

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TOTAL 0 0

Prepared by: Noted by:

MARILOU S. JOVER
Name & Signature of PESO Coordinator MDOII/PESO FOCAL

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