INTAKE SHEET

(AICS Program)

Date of Interview:
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Client's Name:
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CLIENT'S INFORMATION

Age
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Sex
{{ $intake->sex }}

Civil Status
{{ $intake->civilstatus }}

Birthday
{{ \Carbon\Carbon::parse($intake->bday)->format('M j, Y') }}

Birthplace
{{ $intake->bplace }}

Education
{{ $intake->education }}

Religion
{{ $intake->religion }}

Occupation
{{ $intake->occupation }}

Income
{{ $intake->income }}

Address
{{ ($intake->address ?? '') . ', ' . ($intake->barangay ?? '') . ', Cabuyao City' }}

Contact
{{ $intake->contact }}

REPRESENTATIVE'S INFORMATION

Name
{{ ($intake->rfname ?? '') . ' ' . ($intake->rlname ?? '') }}

Age
{{ $intake->rage }}

Sex
{{ $intake->rsex }}

Status
{{ $intake->rcivilstatus }}

Birthday
{{ \Carbon\Carbon::parse($intake->rbday)->format('M j, Y') }}

Contact
{{ $intake->rcontact }}

Education
{{ $intake->reducation }}

Occupation
{{ $intake->roccupation }}

Income
{{ $intake->rincome }}

Religion
{{ $intake->rreligion }}

Address
{{ ($intake->raddress ?? '') . ', ' . ($intake->rbarangay ?? '') }}

Relationship
{{ $intake->rrelationship }}

BENEFICIARY CATEGORY / ASSISTANCE PROVIDED

Target Sector
{{ $intake->sector }}

Sub-category
{{ $intake->subsector }}

Assistance
{{ $intake->assistance_type }}

Type
{{ $intake->subassistance_type }}

Declaration

I declare under oath that all information provided herein is true, correct, and complete. I authorize the City Social Welfare and Development Office to verify and validate all submitted information and acknowledge that any falsification shall subject me to applicable legal action under Philippine laws.

Declaration and Data Privacy Consent
I hereby declare that all information provided herein is true and correct. Pursuant to Republic Act No. 10173 (Data Privacy Act of 2012), I authorize the LGU Cabuyao – Hain Center to collect, process, store, and use my personal information solely for evaluation, validation, processing, monitoring, reporting, and auditing of my assistance request. Said information shall remain confidential and shall only be disclosed when authorized by law.

✓ I voluntarily consent to the lawful processing of my personal data.

Applicant Signature

Interviewed by

RUBY MEL R. REBAYA, RSW

Noted by

Revised Intake Sheet (AICS)

{{-- ========================= FAMILY COMPOSITION PAGE ========================= --}}

FAMILY COMPOSITION SHEET

Household Members of {{ strtoupper($intake->fname . ' ' . $intake->lname) }}

@forelse($intake->familyMembers as $member) @empty @endforelse

FULL NAME	AGE	RELATIONSHIP	CIVIL STATUS	OCCUPATION	MONTHLY INCOME
{{ strtoupper($member->fullname) }}	{{ $member->age }}	{{ strtoupper($member->relationship ?? '') }}	{{ strtoupper($member->civil_status ?? '') }}	{{ strtoupper($member->occupation ?? '') }}	{{ $member->monthly_income ? number_format($member->monthly_income, 2) : '' }}
NO FAMILY COMPOSITION RECORDED
TOTAL HOUSEHOLD MEMBERS					{{ $intake->familyMembers->count() }}