MFR FORM v1.0 | FEB 2009

Republic of the PhilippinesProvince of ____________City of ________________

Attach LogoHere

APPLICATION FOR MUNICIPAL FISHERFOLK REGISTRATION

Registration No.: New Registration

Registration Date: Renewal

Attach Photo Here(1 ½” x 1 ½”)

Photo should be acquiredduring the last six (6)

months

1. PERSONAL INFORMATIONComplete Name

Mr Ms Mrs

Salutation Last Name First Name Middle Name Appellation (Sr, Jr, III)

Address

Street/Barangay City/Municipality Province Postal Code

Contact No. (Cell Phone, Telephone) Resident of the Municipality since(indicate the year)

Age Date of Birth

(M M - D D - Y Y Y Y)

Place of Birth (Municipality, Province)

Gender

Male Female

Height (ft-in) Weight (kg) Skin Complexion

Brown Fair

NationalityFilipino

Others (pls. specify) ___________

Educational BackgroundElementary VocationalHigh School College

Relationship: ConPerson to notify in case of emergency:(First Name, Last Name)

Address: (Barangay, Municipality, Province)

Name of Dependents Date of Birth Relationship Name of Dependents

1. 6.

2. 7.

3. 8.

4. 9.

5. 10.

2. FISHING ACTIVITY PROFILE

Nature of Involvement in FishingPart-Time Full Time

Started fishing since(indicate the year)

PurposeHouseRecrea

3. CAPTURE FISHING ACTIVITY3.1 CATCH

Mode of Fishing(Check all that applies)

Individual/Solo FishingGroup Fishing

Role in Capture Fishing: Owne

Fish

Fishing Ground: Distance to Fishing Ground (km):

Fish Landing (Bagsakan): Est. fuel consumption per trip (liters):

List names of fish caught:PEAKSEASON

Time of fishing: AM ___PM ___

No. of hrs/trip: N

List names of fish caught:LEANSEASON

Time of fishing: AM ___PM ___

No. of hrs/trip: N

3.2 FISHING GEARSName of Gears Total No. of

Units UsedNo. of Units

OwnedNo. of Units

Owned by P.ONo. of UBorrow

WWW.BFAR.DA.GOV.PH

Civil Status

Single Legally SeparatedMarried Widowed

Dark Others _______________

Post-GraduateOthers (pls. specify) _______________

tact No.(Cell Phone, Telephone):

Date of Birth Relationship

of Fishing(Check all that applies)

hold Consumption Livelihoodtional/ Sports fishing Others ____________

r/Operator Fisher

worker Helper / Support

No. of days per month spent in fishing:

Est. cost of fuel per trip:

Average catch per trip (kg):

o. of trips/week:

Average catch per trip (kg):

o. of trips/week:

nitsed

No. of UnitsRented

Measurements

MFR FORM v1.0 | FEB 2009 WWW.BFAR.DA.GOV.PH

4. AQUACULTURE FISHING ACTIVITY

Type of Aquaculture Activity: Grow-out NurseryHatchery

Location (Barangay):

Role in Aquaculture Fishing: Operator/Owner Fishworker

Helper/Support Fish processor

No. of person-days per culture period:

Fuel consumption per culture period (liter): Estimated fuel cost per culture period: Php__________

Feed Type: Commercial Feed Feed consumption per culture period(kg):

Natural Feed Consignacion/Landing Site:

4.1 AQUACULTURE PRODUCTION

SpeciesNo. of Culture Periodper Year

Stocking Density per Culture Period(per hectare or cubic meter)

Production/Harvest per CulturePeriod

(kg)

1. Bangus2. Tilapia3. Prawn4. Seaweed5. Others (please specify)

4.2 AQUACULTURE STRUCTURES/GEARS

Structures/Gears Total Units UsedTotal Units

OwnedTotal Units

Owned by P.OArea / Dimension / Diameter perUnit

1. Fishpond FLA Private2. Fishpen3. Fish Cage4. Lines and Nets5. Others(please specify)

5. FISHING BOAT USED

Name of Boat / Boat No.Boat Type(M=Motorized;

N=Non-Motorized)

Outrigger(W=With Outrigger;

N=No Outrigger)

Fuel Type(G=Gasoline;

D=Diesel; L=LPG)

Horsepower Owned(Y=Yes; N=No)

Ownedby P.O

(Y=Yes; N=No)

GrossTonnage

RegistrationNo.

Dimension(L x W x H) meters

6. LIVELIHOODEstimated Monthly Gross Income

Income from fishing: Php

Income other than fishing: Php

Total Monthly Income: Php

Main Source of IncomeCapture Fishing Fish VendingAquaculture Others (pls. specify) ___________________

Mariculture

Fishing Livelihood Activities Estimated Monthly Income (Php) Fishing Livelihood Activities Estimated Monthly Income (Php)

1. Capture Fishing 4. Fish Vending

2. Aquaculture 5. Others (pls. specify)

3. Mariculture

7. ORGANIZATION

Name of Organization Member Since Position/Official Designation

8. CERTIFICATION THUMBMARKI have personally reviewed the information on this application and I certify under penalty of

perjury that to the best of my knowledge and belief the information on this application is true andcorrect, and that I understand this information is subject to public disclosure.

(Signature over printed name of Applicant) Date Accomplished

9. FOR AUTHORIZED PERSONNEL ONLYReviewed by: Certified Correct by: Approved by:

City Mayor(Signature over printed name) (Signature over printed name) (Signature over printed name)