RBI FORM A

RECORD OF BARANGAY INHABITANTS B

A REGION :
PSG
B PROVINCE : C
O
C CITY/MINICIPALITY : D
E
D BARANGAY : S

E HOUSEHOLD NO.:

NAME (1) ADDRESS (2)

LAST NAME FIRST NAME MEDDLE NAME EXT NO

(1.1) (1.2) (1.3) (1.4) (2.1)

Prepared by: Certified Correct:

Name of Household Head/Member

(Signature Over Printed Name)
RD OF BARANGAY INHABITANTS BY HOUSEHOLD

DATE ACCOMPLISHED:

ADDRESS (2)
PLACE OF DATE OF CIVIL
SEX CITIZENSHIP
NAME OF BIRTH BIRTH STATUS
STREET NAME SUBD/SITIO/PUROK
(If applicable)

(2.2) (2.3) (3) (4) (5) (6) (7)

tified Correct: Validated By:

Barangay Secretary Punong Barangay

(Signature Over Printed Name) (Signature Over Printed Name)
 OCCUPATION

(8)

nong Barangay
e Over Printed Name)