Republic of the Philippines

Province of Pangasinan
MUNICIPALITY OF _____________
BARANGAY __________________
OFFICE OF THE PUNONG BARANGAY

CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that _________________________________________,

___________________ years old is a bonafide resident of Barangay __________________
based on the record kept by this office and is residing in the Barangay up to the present.

He was born on ____________________________________ son/daughter of

___________________________________ and ______________________________________.

This certification is being issued upon his/her request for whatever legal intent or
purposes it may serve.

Issued on the _____ day of ________________, 20_____ ____________________,

____________________, Pangasinan.

_____________________
Punong Barangay