REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF JUSTICE


NATIONAL BUREAU OF INVESTIGATION
REFERENCE NUMBER
NBI CLEARANCE APPLICATION FORM
U7WYPWF3
Sunday Feb 03, 2019 AM
Valid Until Feb 18, 2019
()
APPLICANT TYPE 1. ID PRESENTED 2. PURPOSE TYPE 3. PURPOSE APPLICATION
NEW Driver's license LOCAL MULTI-PURPOSE CLEARANCE
BASIC INFORMATION
5. FAMILY NAME 6. HUSBAND FAMILY NAME (FOR MARRIED WOMAN ONLY)
MONTELIBANO -

7. GIVEN NAME 8. MIDDLE NAME

MARFE JAN ABELLO

9. NICKNAME 10. OTHER NAME/ALSO KNOW AS

- -

11. DATE OF BIRTH 12. BIRTH PLACE

11/25/1995 ISABELA DISTRICT HOSPITAL

13. CITIZENSHIP 14. GENDER 15. CIVIL STATUS

FILIPINO FEMALE SINGLE

16. SPOUSE 17. BIRTH PLACE

- -

18. PRESENT ADDRESS

BRGY. ODIONG MOISES PADILLA NEG. OCC.

19. CONTACT NUMBER 20. EMAIL ADDRESS 21. IDENTIFYING MARKS

09756619991 marfemontelibano23@gmail.com -
ADDITIONAL INFORMATION
22. HEIGHT 23. WEIGHT 24. COMPLEXION 25. RELIGION
162 40 FAIR SEVENTH DAY ADVENTIST

26. EDUCATIONAL ATTAINMENT 27. OCCUPATION

COLLEGE GRADUATE NONE
PARENTS INFORMATION
28. NAME OF FATHER 29. FATHER BIRTH PLACE
GEZER MABAGO MONTELIBANO PONTEVEDRA NEGROS OCCIDENTAL

30. NAME OF MOTHER 31. MOTHER BIRTH PLACE

FEMIA MINANGA ABELLO BARANGAY ODIONG MOISES PADILLA

I certify that I have read and understood all the questions set forth in this application and answer I have furnished on this form are true and correct to the best acknowledge and belief. I understand that any false or misleading
statement is FALSIFICATION PUNISHABLE UNDER ARTICLE 171 & 172 OR REVISEDPENAL CODE

________________________________ ________________________________

36. DATE 37. SIGNATURE

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