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Application Form For Municipal Fisherfolk Registration

This document is an application for municipal fisherfolk registration in the Philippines. It collects personal information such as name, address, contact details, age, civil status, education, number of children, nationality, emergency contact, livelihood details including main source of income, organization membership, and certification by the applicant. The applicant is certifying that the information provided is true and correct. The application is then reviewed, certified correct, and approved by authorized municipal personnel.

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Jun Casono
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16K views1 page

Application Form For Municipal Fisherfolk Registration

This document is an application for municipal fisherfolk registration in the Philippines. It collects personal information such as name, address, contact details, age, civil status, education, number of children, nationality, emergency contact, livelihood details including main source of income, organization membership, and certification by the applicant. The applicant is certifying that the information provided is true and correct. The application is then reviewed, certified correct, and approved by authorized municipal personnel.

Uploaded by

Jun Casono
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines Region VIII ______________________ Municipality of _________ APPLICATION FOR MUNICIPAL FISHERFOLK REGISTRATION Registration No.

: Registration Date: 1. PERSONAL INFORMATION Complete Name


Mr Ms Mrs

Attach Photo Here


(1 x 1 ) Photo should be taken within the last six (6) months

New Registration Renewal

Salutation

Last Name

First Name

Middle Name

Appellation (Sr. Jr, III)

Address
Street/Barangay City/Municipality (indicate the year) Province

Contact No. (Cell Phone, Telephone)

Resident of the Municipality since

Age

Date of Birth (M M D D Y Y Y Y )

Place of Birth (Municipality, Province)

Gender Male Female

Civil Status Single Legally Separated Married Widowed Educational Background Elementary Vocational High School College
___________

No. of Children

Nationality Filipino Others (pls. specify) ________________ Person to notify in case of emergency:
(First Name, Last Name)

Post-Graduate Others (pls. specify)

Relationship:

Contact No. (Cell Phone, Telephone)

Address: (Barangay, Municipality, Province) 2. LIVELIHOOD Main Source of Income: Capture Fishing (specify gear used) __________________________ Aquaculture (specify culture method used)______________________ Fish Vending Gleaning Fish Processing Others (pls. specify) _______________________ 3. ORGANIZATION Name of Organization Member Since Position/Official Designation Other Sources of Income: Capture Fishing (specify gear used) ____________________ Aquaculture (specify culture method used)________________ Fish Vending Gleaning Fish Processing Others (pls. specify) _______________________

4. CERTIFICATION 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.

THUMBARK

___________________________
(Signature over printed name of Applicant)

__________________
Date Accomplished

5. FOR AUTHORIZED PERSONNEL ONLY Reviewed by: _______________________


(Signature over printed name)
MFRS FORM V.2.2| OCT 2012

Certified correct by: _______________________


(Signature over printed name)

Approved by: _______________________


Municipal Mayor (Signature over printed name)
DA-BFAR|WWW.BFAR.DA.GOV.PH

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