Civil Registry Form No.

1A
(Birth-available)

Republic of the Philippines

OFFICE OF THE CIVIL REGISTRAR
APALIT, PAMPANGA

August 2, 2019

TO WHOM IT MAY CONCERN:

We certify that, among others, the following facts

of birth appear in our Register of Births on page 0109 of
book number 008:

Registry number : 7100212

Date of Registration : OCT. 10, 1997
Population Reference No. : 0812-G74CQ03-4
Name of child : BELSAN S. SANTANA JR.
Sex : Male
Date of Birth : May 21, 1974
Place of Birth : HERMOSA, BATAAN
Name of Mother : BARBARA S. STA. ANA
Citizenship of Mother : FILIPINO
Name of Father : BELSAN R. STA. ANA
Citizenship of Father : FILIPINO
Date of marriage of parents : March 22, 1986
Place of marriage of
: LUBAO, PAMPANGA
parents

This is certification is issued to BELSAN S. SANTANA

JR. upon his/her request.

ANASTACIA S. CANLAS
LOCAL CIVIL REGISTRAR

Verified by:

MERCEDITA T. GARCIA
ADMINISTRATIVE ASSISTANT

Amount paid : 50.00 PHP

O.R. Number : 1924364
Date Paid : 2nd AUGUST 2019

Note: A mark, erasure or alteration of any entry invalidates

this certification