RBI FORM A
RECORD OF BARANGAY INHABITANTS BY HOUSEHOLD
A. REGION: PSG
B. PROVINCE:
C
C. MUNICIPALITY: O
D
E
D. BARANGAY: S
E. HOUSEHOLD NO.:
DATE ACCOMPLISHED:
NAME (1) ADDRESS (2)
CIVIL CITIZEN-
PLACE OF BIRTH DATE OF BIRTH SEX OCCUPATION
LAST NAME FIRST NAME MIDDLE NAME EXT NO. NAME OF STATUS SHIP
STREET NAME (2.2) SUBDIVISION/ZONE/SITIO/PURO (3) (4) (5) (6) (7) (8)
(1.1) (1.2) (1.3) (1.4) (2.1) K (if applicable) (2.3)
Prepared by: Certified Correct: Validated by:
FATIMA D. ASAO MAMA T. BAKAR
Name of Household Head/Member Barangay Secretary Punong Barangay
RBI Form B
INDIVIDUAL RECORD OF BARANGAY INHABITANT
REGION CITY/MUN
PROVINCE BGY
I. PERSONAL INFORMATION
NAME:
(Last) (First) (Middle) (Ext)
DATE OF BIRTH: PLACE OF BIRTH:
MM DD YYYY
SEX: MALE CIVIL STATUS: SINGLE WIDOW/ ER
FEMALE MARRIED SEPARATED
CITIZENSHIP:
PROFESSION/OCCUPATION:
RESIDENCE ADDRESS:
House No Street Name
Subdivision Name/Zone/Sitio/Purok
I hereby certify that the above information is true and correct to the best of my knowledge.
Date Accomplished Name/Signature of Person Accomplishing the Form
Attested by:
Left Right
Thumbmark Thumbmark
Barangay Secretary
Household Number
Note: The Household No. shall be filled up by the Barangay Secretary.