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37B ARB Profiling Form
DAR profiling form for agrarian reform beneficiaries
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CARPER LAD Form No. 37-B
New
Renewal
Validation
Updating
LAD-ARB CARDING FORM 1-A: Data Gathering Form
(please see instruction in filling-up the form)
SCREENING QUESTION FOR RESPONDENT: Please check [ ] appropriate box.
Title Holder
Spouse
Child
Other dependent/s
Reason/s for non-availability of the title holder
1.
Name (Last, First, Middle, Appellation)
2.
Relation to title holder
3.
Name of title holder (L, F, M, A)
4.
I.
Name (Last, First, Middle, Appellation)
2.
1.
Reason/s for non-availability of the title holder
Others
ARB PERSONAL PROFILE
ARB ID No.
Last Name
First Name
Middle Name
Appellation
Status (L
- D)@
Address (house no., street name, barangay, municipality, province):
CARPER LAD Form No. 37B/Page 1 of 6
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Place of Birth (municipality, province)
Religion
Date of Birth (mm/dd/yyyy)
Indigenous Cultural Community Group
Age
Male
Number of Children and Dependent(s)
Female
Total
A
-
Primary Level (1-4)
E
-
High School Graduate
B
-
Intermediate Level (5-6)
F
-
College Level
C
-
Elementary graduate
G
-
College Graduate
D
-
High School Level
H
-
Graduate Studies (masters/doctorate)
Name of Spouse(s)
(Complete Name - First Name, Middle Initial, Last Name)
Date of Birth
(mm/dd/yyyy)
Blood Type
(if available)
Civil Status
Tax Identification Number
(If any)
I - Others please specify
(e.g. cartilla, vocational, etc.):
Highest Educational Attainment
Sex
_______________________________
_______________________________
Age
Status (L
- D)@
Highest Educ. Attainment
1.
2.
Name of Children and Dependent(s)
(Complete Name - First Name, Middle Initial, Last Name)
Sex
(M – F)
Date of Birth
(mm/dd/yyyy)
Age
Highest Educ.
Attainment
Relationship
Status (L
- D)@
1.
2.
3.
4.
@
CARPER LAD Form No. 37B/Page 2 of 6
L – Living
D – Deceased
Downloadable Forms at: www.dar.gov.ph free of charge
II.
LAND TENURE STATUS
A. Details of Emancipation Patent (EP)/Certificate of Land Ownership Award (CLOA)/ Leasehold Contracts
*
** Mode
Type
Title/
Lot
of
Location
Serial No.
Type
Acq’n
(EP, CLOA, LH)
Contract No.
(Mun., Brgy.)
* Lot Type:
** Mode of Acquisition:
***Type of Collective CLOA:
B. Status of Cultivation:
EP/CLOA/LH Serial
No.
FL – Farm Lot
CA – Compulsory Acquisition
OLT – Operation Land Transfer
1 – Co-ownership
If Collective CLOA
***
No. of
CLOA Type
ARBs
Area (hectares)
Actual
Per Title
Possession
(estimated)
Date (yyyy/mm/dd)
Major Crops
Planted
ARB
Installation
Title Registration
HL – Home Lot
GOL/KKK – Gov’t Owned Land
GFI – Gov’t Financial Institution Lands
VOS – Voluntary Offer to Sell
VLT/DPS – Voluntary Land Transfer / Direct Payment Scheme
2 – Cooperative
3 – Farmer’s Assn
LE – Landed Estates
STM – Settlements
EP/CLOA HOLDER (HIM/HERSELF)
Period
From
Area (hectares)
To
Farming Role
Directly
Managing
Cultivating
Labor Utilized
Land Transaction, if applicable
Family
Hired
Date
(yyyy/mm/dd)
State Name of Person or Institution
I – Inherited
**** Type of Land Transaction:
****
Type
M – Mortgaged
L – Leased
C. Status of Cultivation: COVERED BY ALTERNATIVE VENTURE ARRANGEMENT (AVA)
EP/CLOA/LH Serial
Type of
Name of Partner/Institution
No.
AVA*****
S – Sold
GV – Transferred to Gov’t
Duration of AVA
From
To
Area (hectares)
LB – Transferred to LBP
Role of ARB
Laborer
Manager
(1) Leaseback
CARPER LAD Form No. 37B/Page 3 of 6
(2) Lease
(3) Joint venture
(4) Marketing Arrangements
(5) Contract Growing
*****Type of AVA
(6) Others, specify
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D. Status of Cultivation: BY OTHERS (N0N- ARB AWARDEE)
Period
EP/CLOA/ LH Serial
Area
No.
(hectares)
From
To
Name
****
Type of Land
Transaction
Relation to ARB
Date
(yyyy/mm/dd)
Remarks
(include date of transfer
action if any)
**** refer to legend use in Item B - column on nature of land transaction
III.
LAND AMORTIZATION
EP/CLOA/LH Serial
No.
Status
Started payment but
stopped
On-going
No payment at all
Remarks
(e.g., date of full payment, date when payment stopped, and reasons why payment stopped)
IV.
Fully paid
SOURCES OF ANNUAL ARB HOUSEHOLD INCOME
A. FARM
Sources
Crop (major and minor)
Livestock and Poultry
Fishery/Fishpond
Total (PhP)
CARPER LAD Form No. 37B/Page 4 of 6
Derived from EP/CLOA/LH
(PhP)
Derived from other
Landholdings (PhP)
Annual Gross Income (PhP)
Remarks
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B. Non-farm (income derived from non-farm productive or rural industry activities e.g. weaving, tricycle, sari-sari store, welding etc.)
Amount of average annual income generated (PhP)
Sources of income
ARB Title Holder
Spouse
Children
Other household
members
Total Income (PhP)
Remarks
Other household
members
Total Income (PhP)
Remarks
C. Off-farm (income derived from working in other farms)
Amount of average annual income generated (PhP)
Sources of income
V.
ARB Title Holder
Children
MEMBERSHIP IN ORGANIZATION
Name of Organization
*Typology
VI.
Spouse
(1) Cooperative
Type*
(2) Irrigators Assn
Address
(3) Farmers Assn
(4) Women’s Org
ACCESS TO SUPPORT SERVICES (For the last 3 years - **Provide additional sheet/s, if necessary)
Type (Pls. check if services have been accessed)
Training ** (Please indicate/specify list of trainings attended - using the attached reference)
1. Credit Assistance
2. Marketing Assistance
•
Farm to market road
3. Basic Social Services
5. Physical Infrastructures
•
Irrigation facilities
Health
•
Bridges
•
Potable water
6. Pre-post harvest facilities
•
Education
7. Livelihood assistance
•
Electricity
•
CARPER LAD Form No. 37B/Page 5 of 6
Inclusive Dates (from – to)
(yyyy/mm/dd - yyyy/mm/dd)
Position
(5) Auto Savings
(6) Federation
(7) Other
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Signature
By EP/CLOA Holder
Thumb Mark
Left
PICTURE
(1” X 1”)
Right
By Respondent
- (by ARB Title Holder ONLY) -
PREPARED BY
Name & Signature
Date
INDEXED BY
Name & Signature
Enumerator :
CHECKED BY
Name & Signature
Date
ENCODED BY
Name & Signature
MARO :
SIGNATURE OVER PRINTED NAME
CARPER LAD Form No. 37B/Page 6 of 6
Date
SIGNATURE OVER PRINTED NAME
Date
