Republic of the Philippines

Province Ilocos Norte

Municipality of Vintar
BARANGAY 4 STA. MARIA

CERTIFICATE OF LIVE BIRTH

Name First Middle Last Ext.

Place “x” on appropriate answer Day Month Year

Sex/Gender Birthday
Male Female
Place of Birth Hospital Barangay Municipality/City Province

Place “x” on appropriate answer

Type of Birth If Multiple Birth, Child was
Single Twin Three or more First Second Third 4th, 5th, etc.
Citizenship Religion
Mother
Name First Middle Last Ext.

Citizenship Religion Occupation Status Birthday Day Month Year

Father
Name First Middle Last Ext.

Citizenship Religion Occupation Status Birthday Day Month Year

For Married Person only………….

CERTIFICATE OF MARRIAGE
Place of Church/Civil/Military Barangay/Office Municipality/City Province

Marriage
Name of HUSBAND WIFE
Contracting First First
Parties Middle Middle
Last Ext. Last
Date of Birth Day Month Year Age Day Month Year Age

Age
Place of Hospital/Barangay City/Municipality Province Hospital/Barangay City/Municipality Province

Birth
Citizenship
House #, Subdivision/Purok/Sitio, Barangay, City/Municipality, Province House #, Subdivision/Purok/Sitio, Barangay, City/Municipality, Province
Residence

Religion
Civil Status
Name of First First
Father Middle Middle
Last Ext. Last Ext.
Occupation
Religion
Citizenship
Name of First First
Mother Middle Middle
Last Last
Occupation
Religion
Citizenship
Residence