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Municipal Fisherfolk Registration Form

This document is an application for municipal fisherfolk registration in the province of Bulacan, Philippines. It collects personal information such as name, address, contact details, livelihood details, and organization membership. The applicant certifies that the information provided is true and correct. Municipal authorities review and approve the application.

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libertygavarra1
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690 views1 page

Municipal Fisherfolk Registration Form

This document is an application for municipal fisherfolk registration in the province of Bulacan, Philippines. It collects personal information such as name, address, contact details, livelihood details, and organization membership. The applicant certifies that the information provided is true and correct. Municipal authorities review and approve the application.

Uploaded by

libertygavarra1
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd

Republic of the Philippines

Attach Province of Bulacan


Logo Here City of MALOLOS
Attach Photo Here
(1 1/2 " x 1 1/2 ")
Photo should be
APPLICATION FOR MUNICIPAL FISHERFOLK REGISTRATION aquired during the last
six (6) months
Registration No.: New Registration
Registration Date: Updating
1. PERSONAL INFORMATION
Complete Name
Mr Ms Mrs
Salutation Last Name First Name Middle Name Appellation (Sr, Jr, III)
Address

Street Barangay City/Municipality Province Postal Code


Contact No. Date of Birth Place of Birth Resident of the Municipality since
(Cell Phone, Telephone) (Municipality, Province) (indicate the year)

(M M - D D - Y Y Y Y
Gender Civil Status Nationality Religion
Single
Legally Seperated Filipino
Male
___Widowed ___Others (pls. specify)
___Married
Female No. of Children On Number of Household Members
Educational Background No. of male No. of female

Elementary Vocational Post- Graduate No. of in-school No. of out of school

High School College Others (pls. specify) No of employed No of unemployed

Other Source of Income (farming) Income Value Php


Household Monthly Income
(fishing/ farm laboring)
Php Other Source of Income (non-farming) Income Value Php

Person to notify in case of emergency Contact No.(Cell Phone, Telephone)


Relationship
(First name, Last Name)
Address (Barangay, Municipality)
With Voter's Yes , ID No. CCT/4Ps Yes IP Yes SAAD Area Yes
ID Benficiary
No No No No

2. LIVELIHOOD
Main source of Income Livelihood Description (gears/species/type)
Capture Fishing Fish Vending
___Aquaculture ___Fish Processing
__Mariculture ___Others (pls. specify)
3. ORGANIZATION
Name of Organization Member Since Position/Official Designation

4. CERTIFICATION THUMBMARK
I have personally reviewed the information on this application and I certify under
penalty of perjury that to the best of my knowledge and belief the information on this
application is true and correct, and that I understand this information is subject to public
disclosure.

(Signature over printed name of Applicant) Date Accomplished


Left Right

5. FOR AUTHORIZED PERSONNEL ONLY


Reviewed by: Certified Correct by: Approved by:

(Signature over printed name) (Signature over printed name) (Signature over printed name)

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