RBI FORM A (Revised 2024)

RECORDS OF BARANGAY INHABITANTS BY HOUSEHOLD

REGION :
PROVINCE:
CITY/MUNICIPALITY:
BARANGAY :
HOUSEHOLD ADDRESS :
NO. OF HOUSEHOLD MEMBERS:

NAME
Indicate if Labor/employed,
Unemployed, PWD, OFW, Solo
PLACE OF BIRTH DATE OF BIRTH AGE SEX CIVIL STATUS CITIZENSHIP OCCUPATION Parent, Out of School Youth
LAST NAME FIRST NAME MIDDLE NAME EXT (OSY), Out of School Children
(OSC) and/or IP

Prepared by: Certified Correct: Validated by:

Name of Household/Head Member Barangay Secretary Punong Barangay

(Signature over Printed Name) (Signature over Printed Name) (Signature over Printed Name)

I hereby certify that the above information are true and correct to the best of my knowledge. I understand that for the Barangay to carry out its mandate pursuant to Section 394 (d)(6) of the Local Government Code of 1991, they must necessarily process my personal information for easy
identification of inhabitants, as a tool in planning, and as an updated reference in the number of inhabitants of the Barangay. Therefore, I grant my consent and recognize the authority of the Barangay to process my personal information, subject to the provision of the Philippine Data
Privacy Act of 2012.