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KR Form 2

KASAMBAHAY MASTERLIST
Quarterly Report
For the Period July - September 30, 2013
Region:
Province:
City/Municipality:
Barangay:

Educational Employment
Attainment
Nature of Work
Arrangement
Salary Membership

L Elem Undergrad 1 -Gen househetp - -


1 Uve in 1. P 1.500 - P1.999 ( Write Y for Yes, and N for No)
Registration
Civil 2. Elem. Grad (ail wound); -
2 Live out 2 P2.000 - P2.459 Name of Employer’s Complete
Control Name of Kasambahay Home Address Sex Age 2 -Yaya
Number Status 3. HSUrvdergrad 3 P2.500 - P 4.999 Employer Address
4, HS Grad 3 - Cook 4 PS .000 and
.
5 Coll. Under rad 4 • Gardener above
6. Coll. Grad
* 5 - Laundry person
7. Vocational 6 - Others sss Pag-IBIG PbiLHeaiih
.
5 Leon Guinto St. Ermita,
-
2013 0001 Santos Ana Martinez 2 Zamora St., San Jose S 25 F 1 2 3 Y N N Juan dela Cruz Manila

Prepared and submitted by:


( Signature over Printed Name )

Position / Designation
Date:

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