Republic of the Philippines

Province of ___________
Municipaly of __________

Barangay ___________

CERTIFICATE OF COHABITATION

Doc No. ______________

To Whom It May Concern,

THIS IS TO CERTIFY that (Name of Husband) , born on (Birthdate) , and

(Name of Wife) , born on (Birthdate) , have been living as a spouses in good
faith, taking on all of the tasks and responsibilities that follow with being in the said relationship,
cohabiting in the same household at (Address of Cohabitation) , and
both holding themselves out to the community as spouses since (Date Start of Cohabitation) .

Given this ____ day of ______, 2021 at Barangay , , __________.

This certification is issued upon the request of the above named persons for
________(Purpose)____________ .

Certified By Attested By

____________________ _______________________
Barangay Secretary Punong Barangay

Community Tax No. ______________

Issued On ______________
Issued At ______________