BARANGAY:_________________________
DATE: ___________________________________
No. Birthday Age
GSIS/SSS/
Name Male Female Soc Pen PVAO Pension
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
GSIS/SSS/
PVAO
SOC PEN Pension NO PEN
Male
Female
Total
Prepared by:
BASCA President
Remarks/Validated
Job Order or Unvalidated
JO Total