Dear Valued Client,: Raquel O. Alivio
Dear Valued Client,: Raquel O. Alivio
I would like to ask for your participation in answering this survey form regarding the
quality of service of the Municipal Civil Registry of Lucban Quezon. I am currently conducting
a study entitle “An Evaluation of the Services Provided by the Civil Registry Office in Lucban
Quezon”. Be assured that your answers will be treated with utmost confidentiality.
Raquel O. Alivio
Researcher
Part 1. Demographic bSurvey. Please provide the necessary information by putting a check
mark on the side provided for in each item.
Marital Status:
____ Single
____ Married
____ Separated
____ Annulled
Record / Document requested from the Municipal Civil Registry Office of Lucban
____ Birth Certificate
____ Death Certificate
____ Certificate of Marriage
____ Others, please specify __________________
Part II. Survey on Service Quality
Please state your level of satisfaction on the services of the Municipal Civil Registry
Office of Lucban Quezon as regards the five dimensions of service quality. You may
use the following legends as you put a check mark on your appropriate boxes below:
5 - Excellent
4 – Very Satisfactory
3 – Satisfactory
2 – Fair
1 – Poor
Reliability 1 2 3 4 5
Responsiveness 1 2 3 4 5
Assurance 1 2 3 4 5
Empathy 1 2 3 4 5
Tangibles 1 2 3 4 5
State-of-the-art documentation