REPUBLIC OF THE PHILIPPINES

CITY OF ROXAS
PROVINCE OF CAPIZ
Barangay Punta Tabuc

OFFICE OF THE PUNONG BARANGAY

BARANGAY CLEARANCE
BARANGAY OFFICIALS: TO WHOM IT MAY CONCERN:

HON. NESTOR A. This is to certify that _______________________________,

BUENVIAJE
Punong Barangay
KAGAWADS:
Hon. Reynaldo B. Barrios
Hon. Edilberto B. Arroyo
Hon. Dionesio M. Rose, Jr.
Hon. Gerardo D. Roxas, Jr.
Hon. Ma. Rossana F. Alcazaren
Hon. Romeo D. De Felipe
Hon. Darwin D. Bunda
Hon. Rejeh Mar Apolinario - SK
BRGY. SECRETARY
Kristelle Anne Mae G. Begalan
______ years old, single/married, a Filipino citizen and a bonafide
resident of Sitio_____________________ Barangay Punta Tabuc,
Roxas City, has not been convicted of any crime involving moral
turpitude, hence maybe considered as a person of good moral character
and deportment.
This certification is issued to the bearer upon the request for
______________________________ and whatever legal purpose it
may serve him / her best.
Issued this _____ day of _____________, 2022 at Barangay
Punta Tabuc, Roxas City, Province of Capiz.

BRGY. TREASURER ______________________

Herminia A. Olmedo (Name of Applicant)

BRGY. RECORD KEEPER C.T.C No. :______________________

Alejandre M. Refugio, Jr. Date Issued :______________________
Place Issued :______________________

Prepared by: Approved by:

KRISTELLE ANNE MAE G. BEGALAN HON. NESTOR A. BUENVIAJE

Barangay Secretary Punong Barangay
(not valid without seal)

__________________________________________________________________
_________________
“Tampad Nga Serbisyo Ang Igahatag Sa Inyo”