Location of the Affected Family

1. Region

4. District

2. Province

5. Barangay

3. City/Municipality

6. Evacuation Center/Site

Head of the Family

7. Last Name

15. Civil Status

8. First Name

16. Mother's Maiden Name

9. Middle Name

17. Religion

10. Name Ext. (Jr., Sr., I)

18. Occupation

11. Birthdate

19. Monthly Family Net Income

12. Age

20. ID Card Presented

13. Birthplace

21. ID Card Number

14. Sex

22. Primary Contact

22. Alternate Contact

23. Permanent Address

House/Block/Lot No.

Street

Subdivision/Village

Barangay

City/Municipality

Province

Zipcode

24. 4Ps Beneficiary

IP - Type of Ethnicity

25. Family Information

Family Members	Relation	Birthdate	Age	Sex	Educational Attainment	Occupation	Vulnerability Type

Note: You can list up to 15 family members.

Republic of the Philippines

Department of Social Welfare and Development

FAMILY ASSISTANCE CARD IN EMERGENCIES AND DISASTERS (FACED)

THIS CARD IS NOT FOR SALE
BENEFICIARYS COPY

OFFICIAL USE ONLY

SERIAL NUMBER

LOCATION OF THE AFFECTED FAMILY

1. REGION

MIMAROPA IV-B

4. DISTRICT

2. PROVINCE

OCCIDENTAL MINDORO

5. BARANGAY

3. CITY/MUNICIPALITY

MAGSAYSAY

6. EVACUATION CENTER/
EVACUATION SITE

HEAD OF THE FAMILY

7. LAST NAME

8. FIRST NAME

9. MIDDLE NAME

10. NAME EXT.
(Jr., Sr., I)

11. BIRTHDATE
(Ex. 01 January 2021)

12. AGE

13. BIRTHPLACE

14. SEX

MALE

FEMALE

15. CIVIL STATUS

16. MOTHER'S MAIDEN
NAME

17. RELIGION

18. OCCUPATION

19. MONTHLY FAMILY
NET INCOME

20. ID CARD PRESENTED

21. ID CARD NUMBER

22. CONTACT NUMBER

PRIMARY

ALTERNATE

23. PERMANENT
ADDRESS

OCCIDENTAL MINDORO

House/Block/Lot No.StreetSubdivision/VillageBarangayCity/MunicipalityProvinceZipcode

24. OTHERS

4Ps Beneficiary

IP- Type of Ethnicity

25. FAMILY INFORMATION

FAMILY MEMBERS	RELATION TO FAMILY HEAD	BIRTHDATE	AGE	SEX	HIGHEST EDUCATIONAL ATTAINMENT	OCCUPATION	TYPE OF VULNERABILITY

26. HOUSE OWNERSHIP

Owner

Renter

Sharer

27. SHELTER DAMAGE CLASSIFICATION

Partially Damaged

Totally Damaged

RIGHT THUMBMARK

Signature/Thumbmark of Family Head

Name/Signature of Brgy. Captain

Date Registered

Name/Signature of LSWDO

28. DATA PRIVACY DECLARATION

All data and information indicated herein shall be used for identification purposes for the implementation of disaster risk reduction and management (DRRM) programs, projects and activities and its disclosure shall be in compliance to Republic Act 10173 (Data Privacy Act of 2012).

FACED Form Entry

Location of the Affected Family

Head of the Family

23. Permanent Address

25. Family Information

26. House Ownership

27. Shelter Damage Classification