w aU CU u ket sued Ey) [NUMBER OF CERTFi€O COPIES REQUESTED: ‘MUMAEROF ORiGHuAL comes RequesTeD: 1 *ean aly be ovalled origin! OMB Cecrance/Certfecton 8 secured |maDE OF ravicer Pleave check VI the appropriate box Ces Poa Money Ore aytete owner plese pce Ceemnes “ote ofthe Onbudinan ‘© fratune teeter torre Fes* Onnseen [OE OF REEASE: Pease chek [ihe appropate box Deewvarmat Loa corer Qofce “preps envelope tobe provided bythe applet © presenhome address [aPPUCRETS INFORMATION: Please PRINT leply Wite"W/A"W nat appliable TOLONGHARI MICHAEL JOHN ORTILLANO Test ome Fis Name Mile ome ‘caren Poston: ‘Serviceman ie Azncyotte Name: Philippine Coast Guard ‘Aereyottce dirs: 139 25th St., Port Area, Manila 4018 Zptose Present ders 00550 Mayor Ignacio Santos Diaz ‘San Martin De Pores House Nok Ho Street Nome ‘areagoy Quezon City 1109 ‘Ge enaiy roe Tptaie pateotsinn: 02/24/1995, contactnes: 09155344799 sex Male mmleetoon Mobieftendne {dedare tat ue answers han above ce tre ad correct thebestof my hnowledge and bl respectfully request your good ofc to sue sdearance in my favor. the collection: Ay steing below, Lagree tothe Ombuduman Pivacy Pai and ahve my consent brocesing of my persona data lnatcordance thereto. 'TOLONGHARI eee ent ate IW CASE APPUCATION Is LED BY AUTHORIZED REPRESENTATIVE OR REQUESTER IN BEHALF OF THE DECEASED PERSON Tat ame Tat Nome ‘Middle Nome ‘etilonte Appllcant/Deceated Bapatare Over Pnted Name oT Cane Oe es Ses