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RCBC Special Project Interview Form

Email* FV Name* Ocular Date* Subject's Name* Subject's Info (Nickname/Age/Birthday/Civil Status)* Residence Address* Residence Complete / Correct Address* Length of Residency* Residency Report Summary*

Subject is confirmed residing at the given addressSubject is not residing at the given addressSubject is an unknown person in the areaMoved outUnlocated Address

Residence moved out new address* Details for unverified residence address* If Renting is there any unpaid rent left? If yes. how much?* Ownership of the residence address*

OwnedParentsRelativesIn-LawsInheritedRentedUsed Free

Subject is living with whom?*

SpouseDomestic PartnerChildrenParentsSiblingsIn-LawsRelativesFriendOther

Residence address type of structure*

BungalowTownhouseCondo UnitOne-Storey BuildingTwo-Storey BuildingMulti-Storey BuildingMansionApartmentShantyCommercial BuidlingOther

Residence address community description*

Exclusive Residential SubdivisionResidentialCommercialMixed Commercial-ResidentialIndustrialMixed Industrial-ResidentialBusiness DistrictSlum Area

Community Income Classification*

High IncomeMiddle IncomeLow Income

Description of Residence Address: (e.g Make. Maintenance etc.)* Residence address Landmark / Distance* Subject's ID/Picture Confirmation? Who Confirmed?* Subject Family Reputation* Subject's Financial Status*

EmploymentBusinessSupport from RelativesOther

Informant 1:(name/address/statement)* Informant 2: (name/address/statement)* Informant 3: (name/address/statement)* Barangay Informant: (name/position/statement)* Business Name* Business Length of Stay at the given address* Business Verification Report Summary*

Business Verification Report SummaryBusiness is not operating at the given addressBusiness is unknown in the areaMove outUnlocated Address

Business moved out new address* Details for unverified business address* If renting, is there any unpaid rent left? If yes, how much? Business address type of structure*

BungalowTownhouseCondo UnitOne-Storey BuildingTwo-Storey BuildingMulti-Storey BuildingMansionApartmentShantyCommercial BuildingOther

Business address community description*

Exclusive Residential SubdivisionResidentialCommercialMixed Commercial-ResidentialIndustrialMixed Industrial-ResidentialBusiness DistrictSlum Area

Description of business address: (e.g Make. Maintenance etc.) Business Address Landmark / Distance* Informant 1: (name/address/statement) Informant 2: (name/address/statement) Informant 3: (name/address/statement) Barangay informant: (name/position/statement) Other relevant information gathered*

Picture of Residence Address*

Picture of Business Address*

Picture of HOA / Admin Office

Picture of Barangay Hall (Residence)*

Selfie Picture of Barangay Hall (Residence)

Selfie Picture of Barangay Hall (Business)*

Selfie Picture of Barangay Hall (Business)*

Picture of Informant 1 Residence

Picture of Informant 2 Residence

Picture of Informant 3 Residence

Picture of Informant 4 Residence

Section

ANTI-SUHOL REPORT

Report within 24 hours if you have experienced any form of bribery in kind or in cash while you were conducting verification.

Did you experience any type of bribery? (Material / Food / Money / Favors) Report the incident and any unlawful activities encountered.*

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