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Client Portal : Registration
Complete this form to register your Client Portal Account.
Registration Form
A. Credentials
Username*
Only alphanumeric (A-Z, 0-9) characters are allowed.
Must be at least 5 characters long
Password*
Email*
Contact Number*
B. Personal Info
First Name*
Last Name*
Middle Name
Suffix
N/A
Jr.
Sr.
I
II
III
IV
V
VI
VII
VIII
IX
X
Birthdate*
Jan
Feb
Mar
Apr
May
June
July
Aug
Sep
Oct
Nov
Dec
Sex*
-- Select --
Male
Female
Other
C. Address
City*
Iloilo City
Barangay*
N/A
Abeto Mirasol Taft South (Quirino Abeto)
Aguinaldo
Airport (Tabucan Airport)
Alalasan Lapuz
Arguelles
Arsenal Aduana
Bakhaw
Balabago
Balantang
Baldoza
Bantud
Banuyao
Baybay Tanza
Benedicto (Jaro)
Bito-on
Bolilao
Bonifacio (Arevalo)
Bonifacio Tanza
Buhang
Buhang Taft North
Buntatala
Burgos-Mabini-Plaza
Caingin
Calahunan
Calaparan
Calubihan
Calumpang
Camalig
Cochero
Compania
Concepcion-Montes
Cuartero
Cubay
Danao
Delgado-Jalandoni-Bagumbayan
Democracia
Desamparados
Divinagracia
Don Esteban-Lapuz
Dulonan
Dungon
Dungon A
Dungon B
East Baluarte
East Timawa
Edganzon
El 98 Castilla (Claudio Lopez)
Fajardo
Flores
General Hughes-Montes
Gloria
Gustilo
Guzman-Jesena
Habog-habog Salvacion
Hibao-an Norte
Hibao-an Sur
Hinactacan
Hipodromo
Inday
Infante
Ingore
Jalandoni Estate-Lapuz
Jalandoni-Wilson
Javellana
Jereos
Kahirupan
Kasingkasing
Katilingban
Kauswagan
Laguda
Lanit
Lapuz Norte
Lapuz Sur
Legaspi dela Rama
Liberation
Libertad-Lapuz
Libertad, Santa Isabel
Loboc-Lapuz
Lopez Jaena (Jaro)
Lopez Jaena Norte
Lopez Jaena Sur
Luna (Jaro)
Luna (La Paz)
M. V. Hechanova
Mabolo-Delgado
Macarthur
Magdalo
Magsaysay
Magsaysay Village
Malipayon-Delgado
Mansaya-Lapuz
Marcelo H. del Pilar
Maria Clara
Maria Cristina
Mohon
Molo Boulevard
Monica Blumentritt
Montinola
Muelle Loney-Montes
Nabitasan
Navais
Nonoy
North Avanceña
North Baluarte
North Fundidor
North San Jose
Oñate de Leon
Obrero-Lapuz
Ortiz
Osmeña
Our Lady Of Fatima
Our Lady Of Lourdes
Pale Benedicto Rizal (Mandurriao)
PHHC Block 17
PHHC Block 22 NHA
Poblacion Molo
President Roxas
Progreso-Lapuz
Punong-Lapuz
Quezon
Quintin Salas
Railway
Rima-Rizal
Rizal (La Paz)
Rizal Estanzuela
Rizal Ibarra
Rizal Palapala I
Rizal Palapala II
Roxas Village
Sambag
Sampaguita
San Agustin
San Antonio
San Felix
San Isidro (Jaro)
San Isidro (La Paz)
San Jose (Jaro)
San Jose (Arevalo)
San Jose (City Proper)
San Juan
San Nicolas
San Pedro (Molo)
San Pedro (Jaro)
San Rafael
San Roque
San Vicente
Santa Cruz
Santa Filomena
Santa Rosa
Santo Domingo
Santo Niño Norte
Santo Niño Sur
Santo Rosario-Duran
Seminario (Burgos Jalandoni)
Simon Ledesma
Sinikway (Bangkerohan Lapuz)
So-oc
South Baluarte
South Fundidor
South San Jose
Taal
Tabuc Suba (Jaro)
Tabuc Suba (La Paz)
Tabucan
Tacas
Tagbac
Tanza-Esperanza
Tap-oc
Taytay Zone II
Ticud (La Paz)
Timawa Tanza I
Timawa Tanza II
Ungka
Veterans Village
Villa Anita
West Habog-habog
West Timawa
Yulo Drive
Yulo-Arroyo
Zamora-Melliza
D. Identity Verification
These will only be used to verify your account and will be deleted after it is either Approved or Declined
Photo of ID
Photo of yourself holding the ID
Submit Registration
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Version 1.5.0