SOCIO-ECONOMIC PROFILE FORM FOR DDOSP APPLICANT

Name of Applicant: Ethnicity

Address: Sex: Contact No:
Age: Course/Strand: School:

A. EDUCATION
1. How many are you in the household?
Kindly fill-out the necessary information needed corresponding to the number in the household. (Start with the head of the family first down to the youngest
member of the household.)

No. Full Name Age Civil Highest School Type Status Salary Range for
(Public/Private) (Working/
Status Educational Working Siblings
Studying)
Attainment
1.

2.

3.

4.

5.

6.

7.

B. INCOME
Father’s Occupation: Mother’s Occupation:
Annual Income Range Annual Income Range
P 129,999 and below P 129,999 and below
P 130,000 – P 179,999 P 130,000 – P 179,999
P 180,000 – P 229,999 P 180,000 – P 229,999
P 230,000 – P 279,999 P 230,000 – P 279,999
P 280,000 – P 329,999 P 280,000 – P 329,999
P 330,000 and above P 330,000 and above
C. HOUSING CHARACTERISTICS (Please check.)
1. Type of building occupied by your household: 7. Have water source? Yes No
a. single house (bungalow, nipa hut, two-storey, barong- 8. Type of fuel household used for cooking:
barong) a. Electricity
b. duplex b. Kerosene
c. apartment / rowhouse c. LPG
d. condominium / condotel d. Charcoal
e. relocation area / housing e. Wood
2. Number of Bedrooms: f. Palay husk / wood shavings
3. Main construction material of the roof: 9. Presence of household conveniences / information &
a. Galvanized iron / aluminum communications technology (ICT) devices / vehicles (If present,
b. Concrete / clay tile kindly specify number)
c. Half-galvanized iron & half concrete A. Household Conveniences
d. Wood / bamboo Refrigerator/freezer
e. Cogon / nipa / anahaw Stove with Oven/Gas Range
f. Asbestos Induction Cooker
g. Makeshift / salvaged / improvised material Air Fryer
4. Construction materials of the outer walls Microwave Oven
a. Concrete/brick/stone Washing machine
b. Wood Air conditioner
c. Half concrete/brick/stone & half wood Electric fan & other cooling equipment
d. Galvanized iron / aluminum B. ICT Devices
e. Bamboo/cogon/nipa Radio/radio cassette (AM, FM & Transistor)
f. Glass Television
g. Makeshift / salvaged / improvised material CD/DVD/VCD Player
h. Concrete hollow blocks Audio component/stereo set/karaoke/videoke
5. Materials of the floor of the housing unit Landline/wireless telephone
a. Ceramic tile/marble/granite Cellular phone
b. Cement/brick/stone Tablet
c. Wood plank Personal computer (desktop, laptop, notebook, netbook &
d. Wood tile others)
e. Vinyl/carpet tile C. Vehicles
f. Linoleum car
g. None jeep
6. Have electricity? Yes No motor cycle / motor scooter
Monthly Billing Range: tricycl
Below P300 pedicab
P301 to P500 van
P501 to P700 truck
P701 to P900 bicycle
P901 to P1,100 boat (M/N)
P1,101 and above

Source: CBMS of PSA

10. List down ownership of livestock, herds, poultry & other farm animals:

Insert photo of the house (outside)

Insert photo of the house (inside)

Remarks :

Name and signature of validator :

Date :

Source: CBMS of PSA