CHECKLIST OF EXTENT OF DAMAGE
Ngaran hin benepisyaryo: Barangay:
City/ Municipality: Province:
Klase han Klamidad: Petsa han Panhitabo:
MGA NARUBA DANYOS REMARKS
o Katunga/ sobra katunga an naruba han atup 30%
o Waray magkatunga an naruba han atup 15%
o Katunga/ sobra katunga an naruba han pamalay 30%
o Waray magkatunga an naruba han pamalay 15%
o Katunga/ sobra katunga an naruba han mga 20%
portahan/ bintana
o Waray magkatunga an naruba han mga 10%
portahan/ bintana
o Katunga/ sobra katunga an naruba han 20%
bongbong
o Waray magkatunga an naruba han 10%
bongbong
KABUG-USAN
o Puydi pa maukyan
o Diri na puydi maukyan
Date of Evaluation:_______________________
Evaluated by: _____________________ Evaluated by: _______________________ Witnessed by: _______________________
(LGU, MEO Staff) (LGU, MSWD Staff) (Brgy. Official)
Evaluated by: _____________________ Evaluated by: _______________________ Concurred by: _______________________
(NHA, Engineering Staff) (NHA, CSSD Staff) (Beneficiary/Representative-Relationship)
CHECKLIST OF EXTENT OF DAMAGE
Ngaran hin benepisyaryo: Barangay:
City/ Municipality: Province:
Klase han Klamidad: Petsa han Panhitabo:
MGA NARUBA DANYOS REMARKS
o Katunga/ sobra katunga an naruba han atup 30%
o Waray magkatunga an naruba han atup 15%
o Katunga/ sobra katunga an naruba han pamalay 30%
o Waray magkatunga an naruba han pamalay 15%
o Katunga/ sobra katunga an naruba han mga 20%
portahan/ bintana
o Waray magkatunga an naruba han mga 10%
portahan/ bintana
o Katunga/ sobra katunga an naruba han 20%
bongbong
o Waray magkatunga an naruba han 10%
bongbong
KABUG-USAN
o Puydi pa maukyan
o Diri na puydi maukyan
Date of Evaluation:_______________________
Evaluated by: _____________________ Evaluated by: _______________________ Witnessed by: _______________________
(LGU, MEO Staff) (LGU, MSWD Staff) (Brgy. Official)
Evaluated by: _____________________ Evaluated by: _______________________ Concurred by: _______________________
(NHA, Engineering Staff) (NHA, CSSD Staff) (Beneficiary/Representative-Relationship)