List of Households Segment Number
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GEOGRAPHIC IDENTIFICATION CAF FORM 1 Republic of the Philippines SHEET OF SHEETS NATIONAL STATISTICS OFFICE AUTHORITY: Section 2(c) of Commonwealth PROVINCE Act (CA) No. 591 authorizes the National Statistics Office to prepare for and undertake all 2012 CENSUS OF CITY/MUNICIPALITY censuses of population, agriculture, industry and commerce. AGRICULTURE AND FISHERIES BARANGAY CONFIDENTIALITY: Section 4 of CA No. 591 ENUMERATION AREA provides that all information furnished on this form are held STRICTLY CONFIDENTIAL. LIST OF HOUSEHOLDS SEGMENT NUMBER AS OF DATE OF VISIT MONTH BUILDING HOUSING HOUSE- NAME OF HOUSEHOLD HEAD ADDRESS OF THE HOUSEHOLD How many How many How many AND DAY SERIAL UNIT HOLD members members members OF VISIT NUMBER SERIAL SERIAL are there are male? are female? L (BSN) NUMBER NUMBER in this I (HUSN) (HSN) household? N E Who is the head of this household? What is the address N of this household? U M B E CALLBACK INDICATOR R WRITE WRITE WRITE THE TOTAL THE TOTAL WRITE X THE TOTAL NUMBER NUMBER IN THE WRITE THE WRITE THE WRITE THE NUMBER OF OF MALE OF FEMALE CIRCLE FOUR -DIGIT FOUR-DIGIT FOUR-DIGIT WRITE THE LAST NAME WRITE THE HOUSE NUMBER HOUSEHOLD HOUSEHOLD HOUSEHOLD IF CALLBACK MEMBERS BSN HUSN HSN AND FIRST NAME AND STREET OR SITIO/PUROK NAME MEMBERS MEMBERS (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) LAST NAME 1 FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 2 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 3 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 4 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 5 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 6 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 7 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME LAST NAME 8 FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME TOTAL TOTAL HH HM MALE FEMALE CERTIFICATION 1A I hereby certify that the data set forth herein were personally obtained/reviewed by me and in accordance with the instructions given by the NSO. ENUMERATOR TEAM SUPERVISOR DSO/SCO CO/RO/PO SUPERVISOR 1 SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME DATE ACCOMPLISHED DATE REVIEWED DATE REVIEWED DATE REVIEWED NSCB Approval No. NSO -1218-01 0 ENUMERATOR’S CODE Expires on October 9, 2013 AGRICULTURE AQUACULTURE FISHERIES TOTAL From January to December 2012,… From January to December 2012,… From January to December 2012,… NUMBER OF Is there any Is there any How many Is there any Is there any How many Is there any Is there any How many OPERATORS member of this member of this agricultural member of this member of this aquacultural member of this member of this fishing IN THE household who household who operators household who household who operators household who household who operators HOUSEHOLD L was engaged in operated a crop are there was engaged in operated a are there was engaged in operated a are there I raising crops, farm, livestock/ in this culturing fish, fishpond, fish in this catching/ fishing activity in this N fruit trees, poultry farm or household? seaweeds or cage, fish pen, household? gathering fish, on catching/ household? E livestock/poultry, other agricultural other aquatic fish tank, crabs, shrimps gathering of fish, mushrooms, farms, or who plants and seaweed farm or or other aquatic crabs, shrimps REMARKS N honeybees or was hired as animals in a other aquafarms, plants and or other aquatic U any agricultural manager of fishpond, fish or who was hired animals? plants and WRITE “0” IF M crops/livestock/ agricultural farm? cage or other as manager of an animals, or who COLUMNS 12, 15 B AND 18 ARE ALL poultry, or types of aquafarm? was hired as a E CODE 2. performed other aquafarm? WRITE THE manager of a OTHERWISE, R agricultural WRITE THE NUMBER OF fishing activity? WRITE THE COPY NUMBER OF AQUACUL- NUMBER OF CORRECTLY activity? AGRICULTURAL TURAL FISHING ENTRY IN C18 1 Yes 1 Yes 1 Yes 1 Yes OPERATORS 1 Yes 1 Yes OPERATORS OPERATORS OF CAF FORM 2 2 No, GO TO 2 No, GO TO IN THE 2 No, GO TO 2 No, GO TO IN THE 2 No, GO TO 2 No, GO TO IN THE OF THIS COLUMN 17 HOUSEHOLD COLUMN 20 COLUMN 20 HOUSEHOLD HOUSEHOLD COLUMN 14 COLUMN 14 HOUSEHOLD COLUMN 17 (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) 1 2 3 4 5 6 7 8 ENGAGED AGRI HA OA ENGAGED AQUA HQ OQ ENGAGED FISHING HF OF TO AS OF DATE OF VISIT MONTH BUILDING HOUSING HOUSE- NAME OF HOUSEHOLD HEAD ADDRESS OF THE HOUSEHOLD How many How many How many AND DAY SERIAL UNIT HOLD members members members OF VISIT NUMBER SERIAL SERIAL are there are male? are female? L (BSN) NUMBER NUMBER in this I (HUSN) (HSN) household? N E Who is the head of this household? What is the address N of this household? U M B E CALLBACK INDICATOR R WRITE WRITE WRITE THE TOTAL THE TOTAL WRITE X THE TOTAL NUMBER NUMBER IN THE WRITE THE WRITE THE WRITE THE NUMBER OF OF MALE OF FEMALE CIRCLE FOUR -DIGIT FOUR-DIGIT FOUR-DIGIT WRITE THE LAST NAME WRITE THE HOUSE NUMBER HOUSEHOLD HOUSEHOLD HOUSEHOLD IF CALLBACK BSN HUSN HSN AND FIRST NAME AND STREET OR SITIO/PUROK NAME MEMBERS MEMBERS MEMBERS (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) 9 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 10 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 11 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 12 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 13 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 14 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 15 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 16 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 17 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 18 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 19 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME 20 LAST NAME FIRST NAME HOUSE NUMBER AND STREET OR SITIO/PUROK NAME TOTAL TOTAL HH HM MALE FEMALE AGRICULTURE AQUACULTURE FISHERIES TOTAL From January to December 2012,… From January to December 2012,… From January to December 2012,… NUMBER OF 1B Is there any Is there any How many Is there any Is there any How many Is there any Is there any How many OPERATORS member of this member of this agricultural member of this member of this aquacultural member of this member of this fishing IN THE household who household who operators household who household who operators household who household who operators HOUSEHOLD was engaged in operated a crop are there was engaged in operated a are there was engaged in operated a are there raising crops, farm, livestock/ in this culturing fish, fishpond, fish in this catching/ fishing activity in this L I fruit trees, poultry farm or household? seaweeds or cage, fish pen, household? gathering fish, on catching/ household? N livestock/poultry, other agricultural other aquatic fish tank, crabs, shrimps gathering of fish, mushrooms, farms, or who plants and seaweed farm or or other aquatic crabs, shrimps E honeybees or any was hired as animals in a other aquafarms, plants and or other aquatic REMARKS N agricultural manager of fishpond, fish or who was hired animals? plants and WRITE “0” IF U crops/livestock/ agricultural farm? cage or other as manager of an animals, or who COLUMNS 12, 15 AND 18 ARE ALL M poultry, or types of aquafarm? was hired as a CODE 2. B performed other aquafarm? WRITE THE manager of a OTHERWISE, E agricultural WRITE THE NUMBER OF fishing activity? WRITE THE COPY NUMBER OF AQUACUL- NUMBER OF CORRECTLY R activity? AGRICULTURAL TURAL FISHING ENTRY IN C18 1 Yes 1 Yes 1 Yes 1 Yes OPERATORS 1 Yes 1 Yes OPERATORS OPERATORS OF CAF FORM 2 2 No, GO TO 2 No, GO TO IN THE 2 No, GO TO 2 No, GO TO IN THE 2 No, GO TO 2 No, GO TO IN THE OF THIS COLUMN 17 HOUSEHOLD COLUMN 20 COLUMN 20 HOUSEHOLD HOUSEHOLD COLUMN 14 COLUMN 14 HOUSEHOLD COLUMN 17 (11) (12) (13) (14) (15) (16) (17) (18) (19) (20) (21) 9 10 11 12 13 14 15 16 17 18 19 20 ENGAGED AGRI HA OA ENGAGED AQUA HQ OQ ENGAGED FISHING HF OF TO CAF FORM 2 Republic of the Philippines AUTHORITY: NATIONAL STATISTICS OFFICE 2A Section 2(c) of Commonwealth Act (CA) No. 591 authorizes the National Statistics Office to prepare for and undertake all censuses of 2012 CENSUS OF AGRICULTURE 2 population, agriculture, industry and commerce. AND FISHERIES CONFIDENTIALITY: Section 4 of CA No. 591 provides that all NSCB Approval No. NSO-1218-02 information furnished on this form are held HOUSEHOLD ROSTER Expires on October 9, 2013 STRICTLY CONFIDENTIAL. CERTIFICATION I hereby certify that the data set forth herein were personally obtained/reviewed by me in accordance with the instructions given by the National Statistics Office. ENUMERATOR TEAM SUPERVISOR DSO/SCO CO/RO/PO SUPERVISOR SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME SIGNATURE OVER PRINTED NAME DATE ACCOMPLISHED DATE REVIEWED DATE REVIEWED DATE REVIEWED SECTION A – GEOGRAPHIC IDENTIFICATION BOOKLET OF BOOKLETS PROVINCE BUILDING CITY/ MUNICIPALITY SERIAL NO.