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Municipal Fisherfolk Registration Form

This document is an application form for municipal fisherfolk registration that collects personal information such as name, address, contact details, livelihood, and organization membership. It requires the applicant to certify that the information provided is true and requests review and approval signatures from authorized personnel. The form is used to register or renew registration for municipal fisherfolk.

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MAO LGU-CLAVER
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288 views1 page

Municipal Fisherfolk Registration Form

This document is an application form for municipal fisherfolk registration that collects personal information such as name, address, contact details, livelihood, and organization membership. It requires the applicant to certify that the information provided is true and requests review and approval signatures from authorized personnel. The form is used to register or renew registration for municipal fisherfolk.

Uploaded by

MAO LGU-CLAVER
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd

Republic of the Philippines

Region VIII
______________________ Attach Photo Here
Municipality of _________ (1 ½ x 1 ½”)

Photo should be taken


APPLICATION FOR MUNICIPAL FISHERFOLK REGISTRATION within the last six (6)
months
Registration No.: New Registration
Registration Date: Renewal
1. PERSONAL INFORMATION

Complete Name
Mr Ms Mrs

Salutation Last Name First Name Middle Name Appellation (Sr. Jr, III)
Address

Street/Barangay City/Municipality Province


Contact No. (Cell Phone, Telephone) Resident of the Municipality since
(indicate the year)

Age Date of Birth Place of Birth (Municipality, Province)

(M M – D D – Y Y Y Y )

Gender Civil Status No. of Children


Male Female Single Legally Separated
Married Widowed
Nationality Educational Background
Filipino Elementary Vocational Post-Graduate
Others (pls. specify) ________________ High School College Others (pls. specify)
___________
Person to notify in case of emergency: Relationship: Contact No. (Cell Phone, Telephone)
(First Name, Last Name)
Address: (Barangay, Municipality, Province)

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

4. CERTIFICATION THUMBARK
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.

___________________________ __________________
(Signature over printed name of Applicant) Date Accomplished
5. FOR AUTHORIZED PERSONNEL ONLY
Reviewed by: Certified correct by: Approved by:

_______________________ _______________________ _______________________


(Signature over printed name) (Signature over printed name) Municipal Mayor
(Signature over printed name)

MFRS FORM V.2.2| OCT 2012 DA-BFAR|[Link]

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