LETTER OF AUTHORIZATION

Philippine Statistics Authority

Date:

TO WHOM IT MAY CONCERN:

I, , of legal age, was born in

in , and resident of hereby

authorize, an online appointment setter/ scheduler to apply and collect PSA- issued
birth certificate(s) with the following information and identity proof details for your
reference and verification process:

Collector’s Name:
Collector’s Identity Type:
Collector’s Identity Number:
Collector’s Signature:

Below you can see the printed scans of valid IDs of both the authorized representative
and the document owner which are necessary to receive the delivered document and
for verification purposes.

The above-mentioned PSA-issued certificate(s) with a number of copies

will be used for
You may contact me for further queries via
Thank you.

Sincerely,