Application Folder

for
Drug Cleared Barangay

Barangay Pinyahan,
Quezon City
 Table of Contents
A. Endorsement Letter
B. Resolution on BADAC Activation
 Bio-Profile of members of BADAC and Auxiliary Team
 Duty Schedule of Rehab Referral Desk
 Photograph of Rehab Referral Desk with Duty
 Mapping and Clustering
 BADAC Action Plan 2019
 Annual Budget 2019
 Drug Awareness Campaign
C. PDEA Certified BADAC Watchlist
D. Training Certificates from DOH
 Initial Screeners
 DDE Practitioners
 For outsource CBRP providers, any DOH related training certifi-
cate of international certification
E. Tokhang Activities
F. Implementation of CBRP
 Activity Design/Module
 Summary of DT Result
 After Activity Report on the Implementation of CBRP
G. Certification based on Section 8 of DDB Regulation 3 Series
2017
H. Color-Coded BADAC Watchlist with Support Documents
 Certifications
I. List of Surrenderees
 Bioprofile of Drug Surrenderees
ENDORSEMENT
LETTER
 Republic of the Philippines
Quezon City
BARANGAY PINYAHAN
No. 25, Malakas St, Barangay Pinyahan, Quezon City
(02) 655-5555; (02) 655-5556

VAL P. YOUNG January 25, 2019

Barangay Chairwoman

MARK CERVANTES
Barangay Councilman DIR III JOEL B PLAZA
Chairman, Oversight Committee on BDCP
VICENTE DELGADO Regional Director, PDEA RO-NCR
Barangay Councilman

ALVIN SANTIAGO
Barangay Councilman Dear Director Plaza,
ANN CADA In support to our President Rodrigo Roa Duterte’s program of eradicating
Barangay Councilwoman
drug menace, being the Chairman of Barangay Pinyahan, Quezon City, I am
one in the campaign that the drug addiction should be stopped to maintain
peace and order in the community.

In view of this, I respectfully endorse Barangay Pinyahan, after complying all

the requirements set forth pursuant to DDB Reg. No. 3, series of 2017.
JET C. TAYAWA
Barangay Secretary Hoping for your consideration.
MEL G .MARTINEZ God bless and more power!
Barangay Treasurer

VAL P. YOUNG
Barangay Chairwoman
 RESOLUTION
BADAC ACTIVATION
 Republic of the Philippines
National Capital Region
Quezon City
Barangay Pinyahan

RESOLUTION NO. 2
Series of 2018

AN ORDER ORGANIZING/ACTIVATION OF BARANGAY ANTI-DRUG ABUSE COUNCIL

OF BARANGAY PINYAHAN, QUEZON CITY

WHEREAS, it is a declared policy of the State to provide effective mechanisms or

measures to re-integrate into society individuals who have fallen victims to drug abuse or danger-
ous drug dependence through sustainable programs of treatment and rehabilitation;

WHEREAS, Section 16 of the Local Government Code of 1991 provides that Local Gov-
ernment Units shall pursue undertakings to improve public and maintain peace and order, among
other equally-significant concerns;

WHEREAS, DILG Memorandum Circular No. 2015-63 re Revitalization of the Barangay

Anti-Drug Abuse Council (BADAC) and their Role in Drug Clearing Operations, emphasized the
principal responsibilities of barangay officials in support of overall government efforts to address
peace and order, particularly to curb illegal drugs and other substances;

WHEREAS, Dangerous Drugs Board ( DDB) Regulation No. 3 Series of 2017 re Strength-
ening the Implementation of Barangay Drug Clearing Program, issued through DILG Memoran-
dum Circular No. 2017-58, provides for operational guidelines in the conduct of the drug clearing
operations at the barangay level, and re-iterated the Powers and Functions of BADAC with its
Composition, the BADAC Committees and the organization of the BADAC Auxiliary Teams.

NOW THEREFORE, I, VAL P YOUNG, Punong Barangay of Barangay Pinyahan, Quezon

City, by virtue of the powers vested in me by law, do hereby order the re-organization of the Ba-
rangay Anti-Drug Abuse Council (BADAC), its Committees and Auxiliary Teams, with their re-
spective functions:

Section I. BARANGAY ANTI-DRUG ABUSE COUNCIL (BADAC)

A. Composition
Chairperson : VAL P YOUNG

Vice Chairman : KAG. MARK CERVANTES

Sangguniang Barangay Member/Chairman, Committee
of Peace and Order

Members : KAG. MEL MARTINEZ

Sangguniang Barangay Member/ Chairman, Committee
of Women and Family
 SK CHAIRMAN NIKKI REYES
Sangguniang Kabataan Chairman/Task Force on Youth Development
Member

MR. COL DELA CRUZ JR.

School Principal (Public, of Principal of any school present
in the Barangay)

DANIELA ARGIE
Tanod Chief/Executive Officer

ABEL B LUNA
Representative of a Non-Government Organization (NGO)
Or Civil Society Organization (CSO)

MR. ALLADIN A. BASIL

Representative of a Faith-Based Organization or any church related
Organization

PINSP CHRISTIAN P STANLY

Adviser/City Chief of Police or Representative

B. Powers and Function of BADAC

1. Plan, strategize, implement and evaluate programs and projects on drug abuse
Prevention in the barangay;

2. Organize the BADAC Auxiliary Team and orient them of their roles and functions
in formulating a plan of action to address to drug problem;

3. Equip Barangay Tanods and BADAC Auxiliary Team on their roles and functions
in the campaign against street-level illegal drug trade through seminars or training;

4. Coordinate and collaborate with other institutions implementing programs and

projects on drug abuse prevention at the barangay level;

5. Conduct an Information Education Campaign on illegal drug demand reduction;

6. Conduct regular and consultative meetings at least once a month and call for
special meetings with organizations in the barangay, such as the Parents
Teachers Community Association (PTCA), Youth Groups, Boy and Girl Scouts,
religious organizations, senior citizens, homeowner associations, neighborhood,
associations, puroks and tricycle operators and drivers association (TODA) and
other organizations existing in the community to get their commitment to assist in
curbing the drug menace in the community whenever necessary;

7. Strengthen the family in the barangay by promoting family affairs and conduct
value formation on parental care and guidance in coordination with other people’s
organization with other people’s organization and concerned agencies;
 8. Determine and maintain a record of the names and other personal information
of actual residents of the barangay, likewise, gather and update all drug-related
incidents and its effect on the peace and order situation in the barangay including
listings of suspected drug users and pushers;

9. Identify drug-affected house clusters, work places, streets, puroks and sitios
where there are violations of RA 9165 and immediately report the same to PNP or
PDEA;

10. Conduct an inventory of drug personalities who were identified to be involved in

illegal drug activities and identify who were brought to both facility and
Community-Based Rehabilitation Centers;

11. Refer suspected drug users to C/MADAC and other institutions for
corresponding counselling or rehabilitation;

12. Refer drug users and dependents who voluntarily surrender to appropriate
officer pursuant to DDB Regulation No. 4 Series of 2016;

13. Conduct periodic monitoring of those undertaking Community Based Drug

Treatment and Rehabilitation through the conduct of random drug testing to
patients who exhibit indication of using dangerous drugs;

14. Empower the community in reporting drug-related cases through an Award/

commendation system;

15. Extend assistance to law enforcement agencies during the conduct of anti-drug
operations. The BADAC Chairman or any elected official present during the anti-
drug operations should sign the inventory of seized drugs and paraphernalia as
witness;

16. Create a favorable policy environment by enacting local ordinances and other
legislative measures

17. Set quarterly targets to reduce the level of drug affectation and ultimately
achieve drug-cleared status and maintain the status of drug-cleared and
unaffected through the ADAC Plan of Action.

18. Submit a monthly report to the C/MADAC copy furnished the DILG City Field
Office;

19. Monitor disposition and progress of drug– related cases filed.

20. Ensure the safety of the community and extend such other necessary
assistance to the operating units during the conduct of anti-drug operations ;

21. Perform other related functions.

 Section 2—BADAC Committees (Pursuant to DILG MC No. 2015-63 and DDB Reg. No. 3,
Series of 2017)

The BADAC shall have the following Committees:

A. Committee on Operations

1. Composition

Chairman : Kagawad Mark Cervantes

Sangguniang Barangay Member/ Chairman, Committee
of Peace and Order

Members : DANIELA ARGIE

Tanod Chief/Executive Officer

BADAC Auxiliary Team Members (25 members per 2,000 barangay population)

1. Jhenson Bugaw 14. Mateo Vida

2. Abegail Carcion 15. Luz Delima
3. Colleen Cruz 16. Rodolf Tapad
4. Lyne Lopez 17. Allan Tano
5. Jam Zales 18. Jess Punzal
6. Vince Cupal 19. Rico Ruiz
7. Thor Vald 20. Elvie Fernando
8. Ryu All 21. Jonafie Hill
9. Thessa Gonzales 22. Arsenio Aquino
10. Edward Collin 23. Eugene Castro
11. Raul Guia 24. Onse Gozon
12. Criselda Arguella 25. Julius Magno
13. Reynal Silao

VAL P. YOUNG MARK CERVANTES VINCENTE DELGADO

Chairman Vice Chairman Kagawad

ANN CADA JET TAYAWA MEL MARTINEZ

 Republic of the Philippines
Quezon City
BARANGAY PINYAHAN
No. 25 St., Barangay Pinyahan, Quezon City
(02) 655-5555; (02) 655-5556

BADAC COMMITTEE AND AUXILLARY TEAM

BIO-PROFILE FORM

PERSONAL DATA
Name Age
Alias Sex
Present Address Provincial Address
Name of Group/Gang Place of Birth
Affiliation (If Any)/ Posi-
tion
Highest Educational Date of Birth
Attainment/ Address
Occupation/ Profession Civil Status
Company/Office Social Media Ac-
counts (Facebook/
Twitter/ Instagram
Technical Skills Cellphone #/
Tel. #
Ethnic Group Height (cm)
Language/Dialect Weight (cm)
Citizenship Eyes Color
Religion Built (S/M/L)
Distinguishing Marks/ Complexion
Tattoo

FAMILIAL DATA
 Republic of the Philippines
Quezon City
BARANGAY PINYAHAN
No. 25, Malakas St, Barangay Pinyahan, Quezon City
(02) 655-5555; (02) 655-5556

REHAB REFERRAL DESK

DUTY SCHEDULE

MEL MARTINEZ - MONDAY

MEL MARTINEZ - TUESDAY
MEL MARTINEZ - WEDNESDAY
MEL MARTINEZ - THURSDAY
JET TAYAWA - FRIDAY
JET TAYAWA - SATURDAY
JET TAYAWA - SUNDAY
 Republic of the Philippines
Quezon City
BARANGAY PINYAHAN
No. 25, Malakas St, Barangay Pinyahan, Quezon City
(02) 655-5555; (02) 655-5556

REHABILITATION REFERRAL DESK

 PDEA CERTIFIED
BADAC WATCHLIST
 CONFIDENTIAL
Republic of the Philippines
Office of the President
PHILIPPINE DRUG ENFORCEMENT AGENCY
REGIONAL OFFICE – NATIONAL CAPITAL REGION
PDEA Annex Bldg.,NIA Northside Road, National Government Center, Barangay Pinyahan, 1100
Quezon City / Telefax: (02) 351-7433 / e-mail address: [email protected]

PDEA/PNP CERTIFIED BADAC WATCHLIST

Barangay Pinyahan, District II, Quezon City

N CLASSIFICA-
NAME ADDRESS REMARKS
O TION
1 Javier, Raymond C. Area 3, Family Compund, Pinyahan, Q.C. Pusher
2 Labayo, Jerry Boy P 521 Area 4, Family Compound, Pinyahan, Q.C. Pusher
3 Mamaril, Elson T. Area 3, Family Compound, Pinyahan, Q.C. User
4 Orate, Marvin L A. Pablo Street, Pinyahan, Q.C. User
5 Organes, Angelo A BSOP Pinyahan, Q.C. User
6 Padua, Yaul B Area 2, Family Compound, Pinyahan, Q.C. User
7 Manalansan, Al Cayetano Street, Pinyahan, Q.C. User
8 Prospero, Michelle T. Manuel Subd., Pinyahan, Q.C. User
9 Quan, Jennifer 54 Cayetano St., Arty Subd., Pinyahan, Q.C. User
10 Rapsing, Ebenezer R 34-B San Guillermo St., Pinyahan, Q.C. User
11 Rivera, Renato R 38-A Mabini St., Arty Subdivision, Pinyahan, Q.C. User
12 Romero, Manjueto L Area 5, Family Compound, Pinyahan, Q.C. Pusher
13 Rapsing, Elmer R 36-B San Guillermo St., Pinyahan, Q.C. User
14 Rapsing, Elmer Reyes 36 San Guillermo St., Pinyahan, Q.C. User

Validated by: Received by:

__________________________ __________________________
Chief of Police BADAC Chairman

__________________________
PDEA District Officer

CONFIDENTIAL
TRAINING CERTIFICATE
FROM DOH
TOKHANG
ACTIVITIES
 Republic of the Philippines
National Police Commission
PHILIPPINE NATIONAL POLICE
Police Station 10, Quezon City

MEMORANDUM

FOR : PCSUPT JOSELITO TEODORO ESQUIVEL JR

District Director, Quezon City

FROM : Station Commander, Police Station 10

SUBJECT : After Activity Report Re: “PROJECT TOKHANG”

DATE : July 30, 2017

1. References:
a. PNP ANTI-ILLEGAL DRUGS CAMPAIGN PLAN (PROJECT DOUBLE
BARREL);
b. Standard Operating Procedure (SOP)

2. At about 9:00 am on July 18, 2017, Police Station 10, Quezon City led by PINSP
Marvin Lokin with the coordination and support of Barangay Pinyahan Officials conducted
documentation of all voluntarily surrendered drug personalities.

3. Attached herewith are the photographs taken during said activity

4. Respectfully submitted for information.

OOA 181030 July 2017, the team proceeded to the house of drug surrenderee Jackson
Lawin and talked to him not to engage again in illegal activities.

OOA 181130 July 2017, the team proceeded to the house of Enrico Reyes and Lando
Reyes, drug surrenderees. Activity ended about 1200.
IMPLEMENTATION
OF CBRP
ACTIVITY DESIGN/
MODULE
AFTER ACTIVITY
REPORTS
 October 11, 2018
Person who uses drugs (PWUDs) first session. It is an orientation regarding
the ill effects of illegal drugs conducted at Brgy. Pinyahan open gym.
 October 20, 2018
Second Session
The Drug surrenderees were thought how to cook simple, easy to cook and
healthy foods that the surrenderees could sell for business. This would
greatly help the surrenderees since mostly, the reasons why they are into
illegal drug activities is because of poverty.
 October 28, 2018
Third Session
Around 5 pm of October 28, 2018, the drug surrenderees had their spiritual
session with Father Melvin Anghel. Father Anghel shared the word of the
Lord and the PWUDs shared each their stories afterwards. The session
ended at about 6:30 pm.
 SUMMARY OF
DRUG TEST RESULT
 Republic of the Philippines
Quezon City
Department of Health
HEALTH DEPARTMENT
City Hall, Diliman, Quezon City
(02) 655-5550; (02) 655-5559

Summary of Drug Test Result

Name Classification Result

Mamaril, Elson T User Negative
Orate, Marvin L User Negative
Organes, Angelo A User Negative
Padua, Yaul B User Negative
Rapsing Elmer R User Negative

NEMESIS R DELA CRUZ, MD, MPH

DDE Practitioner
CERTIFICATION IN PURSUANT TO
PARAMETERS OF SECTION 8, DDB
REG NO. 3 SERIES OF 2017
 Republic of the Philippines
Quezon City
BARANGAY PINYAHAN
No. 25, Malakas St, Barangay Pinyahan, Quezon City
(02) 655-5555; (02) 655-5556

VAL P. YOUNG
CERTIFICATION
Barangay Chairwoman
This is to certify that pursuant to Section 8 of DDB Board Regulation No. 3
MARK CERVANTES
Barangay Councilman Series of 2017, BARANGAY PINYAHAN, QUEZON CITY complied the following
parameters in declaring “DRUG-CLEARED” status, to wit;
VICENTE DELGADO
Barangay Councilman  Non-availability of drug supply
 Absence of drug transit/transshipment activity
ALVIN SANTIAGO  Absence of clandestine laboratory
Barangay Councilman  Absence of clandestine drug warehouse
 Absence of chemical warehouse
ANN CADA  Absence of marijuana cultivation site
Barangay Councilwoman  Absence of drug den, dive, resort
 Absence of drug pusher
 Absence of drug user/dependent
 Absence of protector and financier
 Active involvement of Barangay officials in anti-drug activities
 Active involvement of SK to help maintain the drug-liberated status of the barangay
 Existence of drug awareness, preventive education and information and other relat-
JET C. TAYAWA ed programs
Barangay Secretary  Existence of voluntary and compulsory drug treatment and rehabilitation processing
desk
MEL G .MARTINEZ
Barangay Treasurer Issued this 4th day of January 2019 at Barangay Pinyahan, Quezon City.

Certified by:

_________________ _________________
BADAC Chairman BADAC Vice Chairman

_________________ _________________
BADAC Member BADAC Member

_________________ _________________
BADAC Member BADAC Member

__________________
SK Chairman

Attested by: Verified by:

_________________ _________________
Station Commander PDEA District Officer
 COLOR-CODED
BADAC WATCHLIST
 CONFIDENTIAL
Republic of the Philippines
Quezon City
BARANGAY PINYAHAN
No. 25, Malakas St, Barangay Pinyahan, Quezon City
(02) 655-5555; (02) 655-5556

COLOR-CODED BADAC WATCHLIST

# NAME ADDRESS CLASSIFICATION REMARKS

Deceased
1 Javier, Raymond C. Area 3, Family Compund, Pinyahan, Q.C. Pusher
10/27/2018
Arrested
2 Labayo, Jerry Boy P 521 Area 4, Family Compound, Pinyahan, Q.C. Pusher
12/10/2018
Enrolled (CBRP)
3 Mamaril, Elson T. Area 3, Family Compound, Pinyahan, Q.C. User
10/10/2018
Enrolled (CBRP)
4 Orate, Marvin L A. Pablo Street, Pinyahan, Q.C. User
10/10/2018
Enrolled (CBRP)
5 Organes, Angelo A BSOP Pinyahan, Q.C. User
10/10/2018
Enrolled (CBRP)
6 Padua, Yaul B Area 2, Family Compound, Pinyahan, Q.C. User
10/10/2018
Enrolled (TAHANAN
7 Manalansan, Al Cayetano Street, Pinyahan, Q.C. User Rehab Facility)
11/10/2018
Graduate (CBRP)
8 Prospero, Michelle T. Manuel Subd., Pinyahan, Q.C. User
10/05/2018
Graduate (CBRP)
9 Quan, Jennifer 54 Cayetano St., Arty Subd., Pinyahan, Q.C. User
10/05/2018
Graduate (CBRP)
10 Rapsing, Ebenezer R 34-B San Guillermo St., Pinyahan, Q.C. User
10/05/2018
11 Rivera, Renato R 38-A Mabini St., Arty Subd., Pinyahan, Q.C. User Not Resident
12 Romero, Manjueto L Area 5, Family Compound, Pinyahan, Q.C. Pusher Not Resident
13 Rapsing, Elmer R 36-B San Guillermo St., Pinyahan, Q.C. User Negative DDE
14 Rapsing, Elmer Reyes 36 San Guillermo St., Pinyahan, Q.C. User Same Person to #13

Certified by: Noted by: Attested by:

________________ ________________ ________________

BADAC Chairman PCP Commander Exec. Director/ Action Officer
City ADAC

CONFIDENTIAL
GUIDELINES IN COLOR-CODED BADAC WATCHLIST AND SUPPORTING DOCUMENTS:

REMARKS COLOR SUPPORTING DOCUMENT

ARRESTED RED SPOT REPORT FROM ARRESTING UNIT

(CERTIFIED TRUE COPY) OR
(10/10/2018)
CERTIFICATE OF DETENTION FORM JAIL FACILITY
(ORIGINAL)
DECEASED BLUE DEATH CERTIFICATE
(PHOTOCOPY)
(10/10/2018)

CBRP (ENROLLED) YELLOW CERTIFICATE OF ENROLLMENT

-SIGNED BY CBRP PROVIDER/ADAC
(10/10/2018)
IF ENROLLED IN ADAC PROGRAM
(ORIGINAL)

-SIGNED BY BADAC CHAIRMAN

IF ENROLLED IN BARANGAY
(ORIGINAL)

****ADDITIONAL SUPPORTING DOCUMENTS FOR

PUSHER
CBRP (GRADUATED) YELLOW CERTIFICATE OF COMPLETION
(CERTIFIED TRUE COPY BY ADAC)
(10/10/2018)
****ADDITIONAL SUPPORTING DOCUMENTS FOR
PUSHER
REHAB FACILITY GREEN CERTIFICATE OF ADMISSION
(ENROLLED) SIGNED BY PROGRAM PROVIDER
(ORIGINAL)
(10/10/2018)
COURT ORDER (PHOTOCOPY)
REHAB FACILITY GREEN CERTIFICATE OF COMPLETION
(GRADUATED) (CERTIFIED TRUE COPY)

(10/10/2018)
NOT RESIDENT WHITE CERTIFICATE OF NON-RESIDENCY
SIGNED BY ALL MEMBERS OF BADAC COMMITTEE
(ORIGINAL)
SAME PERSON TO # __ SAME COLOR TO # __ CERTIFICATE OF SAME PERSON
SIGNED BY BADAC CHAIRMAN
(ORIGINAL)
NEGATIVE DDE GRAY CERTIFICATION SIGNED BY DDE PRACTITIONER

(ORIGINAL)
SUPPORTING
DOCUMENTS
 DEATH
CERTIFICATE
SPOT REPORT
NEGATIVE DDE
CERTIFICATE
 Republic of the Philippines
Quezon City
Department of Health
HEALTH DEPARTMENT
City Hall, Diliman, Quezon City
(02) 655-5550; (02) 655-5559

CERTIFICATION

This is to certify that ELMER R RAPSING, 28 years old (DOB:10/08/1990 POB: Quezon City), single, Filipino
and a resident of #5 Conyo Street, Pinyahan, is found NEGATIVE during Drug Dependency Examination (DDE) on
January 1, 2019 to January 5, 2019.

This is to further certify that the undersigned examined Mr. RAPSING through series of interventions and labor-
atory procedures.

This certification is issued in compliance as pursuant to Dangerous Drugs Board Regulation Number 3 Series
of 2017.

Done this 4th day of January, 2019 at Quezon City.

NEMESIS R DELA CRUZ, MD, MPH

DDE Practitioner
CERTIFICATE OF
NON-RESIDENCY
 Republic of the Philippines
Quezon City
BARANGAY PINYAHAN
No. 25, Malakas St, Barangay Pinyahan, Quezon City
(02) 655-5555; (02) 655-5556

VAL P. YOUNG
Barangay Chairwoman CERTIFICATION
MARK CERVANTES
Barangay Councilman
This is to certify that the following personalities are not existing or living in this
VICENTE DELGADO Barangay, to wit:
Barangay Councilman

ALVIN SANTIAGO Renato R. Rivera

Barangay Councilman Manjueto L Romero
ANN CADA
Barangay Councilwoman
This certification is issued in compliance as pursuant to Dangerous Drugs
Board Regulation Number 3 Series of 2017.

Issued this 4th day of January 2019 at Barangay Pinyahan, Quezon City.

JET C. TAYAWA
Barangay Secretary
VAL P. YOUNG
MEL G .MARTINEZ Barangay Chairman
Barangay Treasurer

ATTESTED BY:

PSI STENELY ARAO

Acting Chief of Police
QCPD PS 10
 CERTICATE
OF COMPLETION
REHAB ENROLLMENT
CERTIFICATE
 Republic of the Philippines
Quezon City
Office of the Mayor
Quezon City Drug Treatment and Rehabilitation Center
TAHANAN
Molave Ext, Barangay Payatas, Quezon City
(02) 655-5553; (02) 655-5554

CERTIFICATE OF ADMISSION

This is to certify that AL MANANSALA, 28 years old (DOB:10/10/1990 POB: Quezon City), single, Filipino and
a resident of #3 Cayetano Street, Pinyahan, Quezon City has been admitted here in Quezon City Drug Treatment and
Rehabilitation Center – TAHANAN.

This certification is issued upon request for whatever legal purpose it may serve.

Done this 4th day of January, 2019 at Quezon City.

FLORIAN MEDINA, RSW

OIC – Program Director
CBRP ENROLLMENT
CERTIFICATE
 Republic of the Philippines
LOGO OF LGU LGU LOGO OF CHO
LETTERHEAD OF CITY HEALTH OFFICE

DATE

CERTIFICATION

This is to certify that the following residents of Barangay___, Zone ___, under Chairman
_____________________ are presently enrolled in the (Program) of the City/Municipality Anti-Drug Abuse Councile:

Name
1. E.T. M (Initials Only)
2. M.L.O
3. A.A.O
4. Y.B.P

This certification is issued upon the request of Chairman _____ for the purpose of fulfilling one of the require-
ments of the Barangay Drug Clearing Operations Program.

________________________ ________________________
DOH Accredited Physician Chairman City/Municipal Anti-Drug Abuse Council
 Republic of the Philippines
Quezon City
BARANGAY PINYAHAN
No. 25, Malakas St, Barangay Pinyahan, Quezon City
(02) 655-5555; (02) 655-5556

VAL P. YOUNG
Barangay Chairwoman CERTIFICATION
MARK CERVANTES
Barangay Councilman
This is to certify that the following personalities are enrolled here in the Com-
VICENTE DELGADO munity Based Rehabilitation Program (CBRP) Quezon City, to wit:
Barangay Councilman

ALVIN SANTIAGO Name Date Of Enrollment

Barangay Councilman Mamaril, Elson T. October 10, 2018
Orate, Marvin L October 10, 2018
ANN CADA Organes, Angelo A October 10, 2018
Barangay Councilwoman
Padua, Yaul B October 10, 2018

This certification is issued in compliance as pursuant to Dangerous Drugs

Board Regulation Number 3 Series of 2017.

JET C. TAYAWA Issued this 4th day of January 2019 at Barangay Pinyahan, Quezon City.
Barangay Secretary

MEL G .MARTINEZ
Barangay Treasurer

VAL P. YOUNG
Barangay Chairman

ATTESTED BY:

Chairman City/Municipal Anti-Drug Abuse Council

 LIST OF DRUG
SURRENDEREES
 CONFIDENTIAL
Republic of the Philippines
Quezon City
BARANGAY PINYAHAN
No. 25, Malakas St, Barangay Pinyahan, Quezon City
(02) 655-5555; (02) 655-5556

LIST OF DRUG SURRENDEREES

NAME GENDER AGE CLASSIFICATION ASSESSMENT PROGRAM
1. E.M. M 35 User Mild CBRP
2. M.O. M 22 User Low CBRP
3. A.O. M 27 User Low CBRP
4. Y.P. M 38 User Low CBRP
5. A.M. M 45 User Mild TAHANAN Rehab Facility
6. M.P. F 41 User Mild CBRP Completed
7. J.Q. F 22 User Mild CBRP Completed
8. E.R. M 33 User Mild CBRP Completed

This is to certify that the above listed personalities of the barangay were referred and processed for Drug De-
pendency Evaluation.

________________________
DOH/DMO

Attested by:

________________________
C/MADAC Executive Director

CONFIDENTIAL
BIOPROFILE OF DRUG
SURRENDEREES
 Republic of the Philippines
Quezon City
BARANGAY PINYAHAN
No. 25 St., Barangay Pinyahan, Quezon City
(02) 655-5555; (02) 655-5556

SURRENDEREES
BIO-PROFILE FORM

PERSONAL DATA
Name Age
Alias Sex
Present Address Provincial Address
Name of Group/Gang Place of Birth
Affiliation (If Any)/ Posi-
tion
Highest Educational Date of Birth
Attainment/ Address
Occupation/ Profession Civil Status
Company/Office Social Media Ac-
counts (Facebook/
Twitter/ Instagram
Technical Skills Cellphone #/
Tel. #
Ethnic Group Height (cm)
Language/Dialect Weight (cm)
Citizenship Eyes Color
Religion Built (S/M/L)
Distinguishing Marks/ Complexion
Tattoo

FAMILIAL DATA
SPOUSE FATHER MOTHER
Name
Present Address
Date of Birth
Place of Birth
Age
Occupation/ Profession
CHILDREN AGE CHILDREN AGE