RBI Form B (Revised 2024)

INDIVIDUAL RECORDS OF BARANGAY INHABITANT

REGION : ____ CITY/MUN :

PROVINCE : BARANGAY :

PERSONAL INFORMATION

(PhilSys Card No.)

(Last Name) (Suffix, e.g., Jr., I, II, III) (First Name) (Middle Name)

(Birth Date: mm/dd/yyyy) (Birth Place) (Sex) (Civil Status) (Religion)

(Residence Address) (Citizenship)

(Profession / Occupation) (Contact Number) (E-mail Address)

HIGHEST EDUCATIONAL ATTAINMENT: ELEMENTARY HIGH SCHOOL COLLEGE POST GRAD VOCATIONAL

Please specify: Graduate Under Graduate

I hereby certify that the above information is 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.

___________________________ --------------------------------------------------------------------
Date Accomplished Name/Signature of Person Accomplishing the Form

Attested By:

______________________________
Barangay Secretary Left Thumbmark Right Thumbmark

Household Number:

Note: The household number. shall be filled up by the Barangay Secretary.