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Census Form
AFAB form for census
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: 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
I certify that the information stated above are true and correct to the best of
my knowledge.
Interviewed by
Two Months Deposit
Signature of Lessee
Name, Signature, Designation & Date
Noted by
DONIA G. ALONZO
Division Manager A, CSD/FRD
CSD-FRD-FM-008 rev 000 - Census Form
