CONTROL NO:

HOME OWNER'S INFORMATION

SHEET

BLOCK: LOT: BILANG NG UNIT:

NAME OF PRIMARY HOMEOWNER:

FIRST NAME: MIDDLE NAME LASTNAME SUFFIX

Email Add: __________________________________ Contact No._____________________ Sex:_________________________
Name of Company:_____________________________In Service [ ] Retired [ ] AWOL [ ]
Designation/Position: ____________________ Government: [ ] Private: [ ] Place of Assignment:__________________
Work Phone No. __________________________ Work Address:__________________________
Date of Birth: ____/____/____ Place of Birth:____________________Age : _________________Status:_______________
Alternate Address:____________________________________________________________________________________

NAME OF SPOUSE/PARTNER :

FIRST NAME: MIDDLE NAME LASTNAME

Email Add: __________________________________ Contact No: _____________________ Sex:_______________________
Name of Company:_____________________________In Service [ ] Retired [ ] AWOL [ ]
Designation/Position: ____________________ Government: [ ] Private: [ ] Place of Assignment:__________________
Work Phone No. __________________________ Work Address:__________________________
Date of Birth: ____/____/____ Place of Birth:____________________Age : _________________Status:_______________
Alternate Address:__________________________________________________________________________________
Date of Marriage :_____________________________Place of Marriage: ______________________________________

Pangalan ng Birth order Age Birthdate Birth Place Contact No. School-Course
anak: /Company- Position

Pangalan ng iba kasama Relation Age Birthdate Birth Place Contact No. School-Course
kasama sa bahay: /Company- Position
May Senior Citizen ba na kasama kayo sa bahay? YES [ ] NO [ ]
Name of Senior Citizen:_______________________________________________________________________________
Age:_____ Sex: ________ Status:________________Birthdate:______________BirthPlace:_________________________
May Senior Citizen ID na ba? YES [ ] NO [ ] Senior Citizen ID Card No:_________________________________
Place of Issued:________________________________________

May PWD ba na kasama kayo sa bahay? YES [ ] NO [ ]

Name of Person With Disability:_________________________________________________________________________
Age:_____ Sex: ________ Status:________________Birthdate:______________BirthPlace:________________________
Type of Disability:____________________________________May PWD ID na ba? YES [ ] NO [ ]
PWD ID No:______________________Place Issued:_________________________

May sasakyan ba? YES [ ] NO [ ]

KLASE NG SASAKYAN Model Kulay Plate No.

Pangalang ng mga botante sa bahay Lugar kung saan Nakarehistro Precint No.

Ang lahat ng impormasyong nakasaad sa taas ay pawang katotohanan lamang.

________________________________
Nagpapatunay at Lagda

Ang mga nakalap na mga impormasyon na galing sa inyo ay gagamitin po namin sa office ng Home Owners Association
sa preparasyon sa pag update ng renter at masterlist at iba pang vital information or reports na kailangan ng NHA at ng Local
Government Unit ng Naic para sa mga ayuda galing sa DSWD at isa ba pang mga National Agencies.
Makakaasa po kayong manatiling CONFIDENTIAL ang inyong mga vital inforamtion. Tanging ang HOA Office lamang ang may karapatan
mag magbigay ng info kong kinakailangan. Sana po ay makipagtulungan tayo sa ikakaunlad ng ating lugar. Maraming salamat po.

KARAGDAGANG SURVEY

Total bilang ng namamalagi sa sambahayan: _________

Total bilang ng Senior sa sambahayan: _________
Total bilang ng PWD sa sambahayan: _________
Total bilang ng edad:
18 below __________
18-59 __________
60 above __________
Total bilang ng miyembro ng 4PS: __________
Total bilang ng may bakuna: __________
Total bilang ng alagang aso: __________
Total bilang ng botante: __________
Total bilang ng studyante: __________
Total bilang ng may trabaho: __________
Total bilang ng Kristyano: __________
Total bilang ng Muslim: __________
Total bilang ng sasakyan: __________

May Negosyo: YES [ ] NO [ ] Uri ng Negosyo:_________________________