CSD-FRD-FM-008 rev 000 - Census Form.pdf - Google Drive

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AUTHORITY OF THE FREEPORT AREA OF BATAAN

APARTMENT/DORMITORY CENSUS FORM Personal Information

Dormitory/Apartment Unit Information

Lessee Name (Last, First, & Middle Name)

Sex

o Male

o Female

Age

Building Name

Unit Number

Civil Status o Married o Single o Living Common Law (check one) o Separated o Divorced o Widowed Provincial Address

Number

Block, Street

AFAB Employer/Company

Barangay

Municipality

Contact Person in Province (Last, First, & Middle Name)

Contact Details (telephone/email) Rental Amount

Length of Stay (years & months)

Province

Contact Person Contact Details (telephone/email)

Remarks

Occupant Information (attached additional sheet if necessary) Name

Age

Sex

Civil Status

Relation to Lessee

Company/Employer/School

Position

Net Income

Date of Occupancy Religious Affiliation

Remarks (to be filled by the inteviewer)

Certification New Award

AFAB Official Reciept Number

Contract Effectivity Date

One Month Advance

Notarial Date

Two Months Deposit

I certify that the information stated above are true and correct to the best of my knowledge.

Signature of Lessee

Interviewed by

Name, Signature, Designation & Date

Noted by

DONIA G. ALONZO Division Manager A, CSD/FRD CSD-FRD-FM-008 rev 000 - Census Form