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ARBDSP FORM M&E FORM 16
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NAME OF DESIGNATED ARB HOUSEHOLD REPRESENTATIVE
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CRITERIA IN DESIGNATING AN ARB HOUSEHOLD REPRESENTATIVE:
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1. The original ARB indicated in the EP/CLOA is DEAD.
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2. The original ARB indicated in the EP/CLOA has a SEVERE ILLNESS and can no longer till or manage the awarded land.
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3. The original ARB indicated in the EP/CLOA can no longer till or manage the awarded land because of OLD AGE.
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4. The designated ARB Household Representative is presently the tiller and managing the awarded land.
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*If the criteria were met, an ARB can designate one (1) ARB Household Representative.
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COLUMN NO.
COLUMN NAMEDESCRIPTION
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1REGIONIndicate the Regional location of the landholdings distributed to ARBs.
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2PROVINCEIndicate the Provincial location of the landholdings distributed to ARBs.
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3CDIndicate the Congressional District location of the landholdings distributed to ARBs.
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4MUNICIPALITY / CITYIndicate the Municipal location of the landholdings distributed to ARBs.
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5BARANGAYIndicate the Barangay location of the landholdings distributed to ARBs.
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6ARC/NON-ARC/SARCIndicate if the landholdings distributed to ARBs is located within ARC, SARC; or Non-ARC area.
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7NAME OF ARCIf the landholdings is located within ARC and SARC, please provide the name of the ARC.
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8NAME OF ARC CLUSTERIf the landholdings is covered by ARC Cluster, please provide the name of the ARC Cluster.
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9ARB ID NO.Indicate the ARB Idenfitication Number provided by DAR.
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10NAME OF ARB EP/CLOA HOLDER
Provide the Full Name of the ARB indicated in the EP/CLOA certificate with this format: Last Name, First Name, i.e. Clemente, Jonel
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11TYPE OF LAND CERTIFICATE RECEIVEDIndicate if the land certificate awarded to ARB is an EP or CLOA.
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12EP/CLOA NO.Provide the EP/CLOA number indicated in the certificate received by the ARB.
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13LOT NO.Provide the Lot Number indicated in the EP/CLOA certificate.
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FULL ADDRESS OF THE LAND AWARDED TO THE ARB
Provide the full address of the land awarded to the ARB.
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15NAME OF ARBO AFFILIATIONProvide the full name of the ARBO affiliation of the ARB, followed by the ARBO acronym.
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16NAME OF DESIGNATED ARB HOUSEHOLD REPRESENTATIVEProvide the Full Name of the Designated ARB Household Representative with this format: Last Name, First Name, i.e. Clemente, Jonel.

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17SEXIndicate if Male or Female
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18RELATIONSHIP TO THE ARBIndicate the relationship to the ARB, i.e. Father, Mother, Brother, Sister, etc…
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19REASON FOR DESIGNATING AN ARB HOUSEHOLD REPRESENTATIVEIndicate if DEAD, SEVERE ILLNESS, OR OLD AGE
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20REMARKSRefers to critical additional information not captured in any of the columns.
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