Office Of Senior Citizen Affairs
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OFFICE OF SENIOR CITIZENAFFAIRS Registration Form ___________________________________________________________________ (PANGALAN/GIVEN NAME) (PANGGITNA/MIDDLE NAME APELYIDO/SURNAME) (TIRAHAN SA LUNGSOD / CITY ADDRESS)
(BARANGAY)
(KAPANGANAKAN / BIRTHDAY)
(SAAN IPINANGANAK / BIRTHPLACE)
(HANAP-BUHAY / OCCUPATION)
(ESTADO / CIVIL STATUS)
(IBANG GAWAIN / OTHER SKILLS)
(GULANG / AGE) (KASARIAN / SEX)
(SANG TAONG KITA / ANNUAL INCOME) (PENSYON / PENSIONER)
(PINAKAMATAAS NA PINAG-ARALAN/HIGHEST EDUCATION ATTAINMENT)
(KAILAN TINAPOS/YEAR GRANTED)
KASAMBAHAY: HOUSEHOLD COMPOSITION PANGALAN/ NAME
RELASYON / RELATION
GULANG / AGE
ESTADO / CIVIL STATUS
HANAPBUHAY/OCCUPATION
(GAMITIN ANG LIKOD KUNG KINAKAILANGAN / USE THE BACK IF NECESSARY) ANGALAN NG SAMAHAN / NAME OF ASSOCIATION ____________________________________________________
LUGAR / ADDRESS ___________________________________________
____________________________________________________
___________________________________________
Pinatutunayan ko na ang lahat ng nasasaad sa itaas nito ay pawing katotohanan sa abot ng aking kaalaman at paniniwala. Gayundin, ako’y laang sumapi sa samahang “ELDERLY” sa Barangay na aking kinabibilangan. ____________________________________________ ELDERLY ASSOCIATION
__________________________________________________ (LAGDA NG NAGPATALA)
BRGY. _____________________, LUCENA CITY Kung hindi nakapirma, tatakan ng inyong hinlalaki (Thumbmark) at lagyan ng saksi ang aplikasyong ito at isulit sa tanggapan ng OSCA at lakipan ng larawan. Rehistrasyon ay P 10.00 O.R. _______________________ _________________________________________________ Petsa _______________________ LAGDA NG SAKSI
OTHER REMARKS (OSCA CLERK) ___________________________________________
_________________________________________________ PETSA NG PAGPAPATALA SEDULA NO. _____________________________________ KUHA SA ________________________________________ PETSA ___________________________________________
___________________________________________ FEDERATION OF ELDERLY ASSOCIATION OF LUCENA CITY RAC Compound, Old Motorpool, Zaballero Subdivision Brgy. Gualng-Gulang, Lucena City 4301 Telephone: (042) 373-6869 / 660-8384
(BARANGAY)
(KAPANGANAKAN / BIRTHDAY)
(SAAN IPINANGANAK / BIRTHPLACE)
(HANAP-BUHAY / OCCUPATION)
(ESTADO / CIVIL STATUS)
(IBANG GAWAIN / OTHER SKILLS)
(GULANG / AGE) (KASARIAN / SEX)
(SANG TAONG KITA / ANNUAL INCOME) (PENSYON / PENSIONER)
(PINAKAMATAAS NA PINAG-ARALAN/HIGHEST EDUCATION ATTAINMENT)
(KAILAN TINAPOS/YEAR GRANTED)
KASAMBAHAY: HOUSEHOLD COMPOSITION PANGALAN/ NAME
RELASYON / RELATION
GULANG / AGE
ESTADO / CIVIL STATUS
HANAPBUHAY/OCCUPATION
(GAMITIN ANG LIKOD KUNG KINAKAILANGAN / USE THE BACK IF NECESSARY) ANGALAN NG SAMAHAN / NAME OF ASSOCIATION ____________________________________________________
LUGAR / ADDRESS ___________________________________________
____________________________________________________
___________________________________________
Pinatutunayan ko na ang lahat ng nasasaad sa itaas nito ay pawing katotohanan sa abot ng aking kaalaman at paniniwala. Gayundin, ako’y laang sumapi sa samahang “ELDERLY” sa Barangay na aking kinabibilangan. ____________________________________________ ELDERLY ASSOCIATION
__________________________________________________ (LAGDA NG NAGPATALA)
BRGY. _____________________, LUCENA CITY Kung hindi nakapirma, tatakan ng inyong hinlalaki (Thumbmark) at lagyan ng saksi ang aplikasyong ito at isulit sa tanggapan ng OSCA at lakipan ng larawan. Rehistrasyon ay P 10.00 O.R. _______________________ _________________________________________________ Petsa _______________________ LAGDA NG SAKSI
OTHER REMARKS (OSCA CLERK) ___________________________________________
_________________________________________________ PETSA NG PAGPAPATALA SEDULA NO. _____________________________________ KUHA SA ________________________________________ PETSA ___________________________________________
___________________________________________ FEDERATION OF ELDERLY ASSOCIATION OF LUCENA CITY RAC Compound, Old Motorpool, Zaballero Subdivision Brgy. Gualng-Gulang, Lucena City 4301 Telephone: (042) 373-6869 / 660-8384
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