Taytay, Palawan | Online Services

Republic of the Philippines

Province of Palawan

Municipality of Taytay

APPLICATION FOR MUNICIPAL FISHERFOLK REGISTRATION

New Registration

Renewal

Transferee

Complete Name
Salutation

Mr.

Ms.

Mrs.

Last Name

First Name

Middle Name

Suffix(Sr.Jr.III)

Address

Street/Barangay

City/Municipality

Province

Fishing Ground

FMA Number

Full Time

Part Time

Contact No.(Cellphone,Telephone)

Resident of Municipality since

Date of Birth

Age

Place of Birth

Sex

Civil Status

Number of Children

Total Number of Household

Number of Male

No. of In-School

No. of Employed

Number of Female

No. of Out-of-School

No. of Un-Employed

Educational Background

Nationality

Religion

Household Monthly Income (PhP)

Person to notify incase of emergency

Relationship

Contact No.(Cellphone/Telephone)

Address:

With Voters ID?

Yes.

No.

CCT/4Ps?

Yes.

No.

Indigenous Cultural Community(IP)?

Yes.

No.

ID No.:

Barangay Verification (verified true and correct)

Signature

Name

Position

Date

LIVELIHOOD

Mainsource of Income

Capture Fishing

Aquaculture

Fish Vending

Gleaning

Fish Processing

Others(pls. specify)

Other Sources of Income

Capture Fishing

Aquaculture

Fish Vending

Gleaning

Fish Processing

Others(pls. specify)

ORGANIZATION

Name of Organization

Member Since

Position/Official Designation

CERTIFICATION

I have personally reviewed the information on this application and I certify that under penalty of perjury that to the best of my knowledge and belief the information on this application is true and corect, and that I understand this information is subject to public

Signature/over printed name

Date accomplished

THUMBMARK