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Department of Agriculture (FORM 1)

Philippine Rural Development Project (PRDP)


ENTITLEMENT SURVEY AFFECTED PERSONS

Date of Survey : ____________________________________________________________


Household Survey No : ____________________________________________________________
Name of Respondent : ____________________________________________________________
Affiliation with Houseold Head :____________________________________________________________

Component I-Build SP-ID No. Barangay


HOUSEHOLD COMPOSITION
Estimated
Name of Household Gender Ethnicity if IP Occupation &
Age Total
Head & Members (F/M) Only Source of Income Income/yr

Landholdings Lot No. PIs No. ______________


Parcellary No. ______________________
Tenurial Status
Quantity and (owned/rented,
Properties to be affected by the Project ENTITLMENTS
Cost tenant etc.)
A. LAND
1. Residential
2. Commercial
3. Agricultural
B. CROPS
1. Rice
2. Corn
C. TREES (Specity Age)
1.
2.
D. STRUCTURES
1. Permanent
2. Temporary
E. ECONOMIC LOSES
1. Business Losses
2. Income Losses
3. Temporary Losses

Survey Conducted by: PPMIU Representative

_____________________________________________ _____________________________________________
Punong Barangay Printed Name and Signature

Conforme:

________________________________________________
Name and Signature of HH/ Authorized Representative
Entitlement Survey Form/Isabela

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