Republic of the Philippines

Province of ____________
Municipality of ____________
BARANGAY _____________
-o0o-
OFFICE OF THE PUNONG BARANGAY

BARANGAY CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that __________________, Filipino citizen and a bonafide

resident of Purok _________, Barangay _________________________.

This is to further certify that the above named person is the same person whose
information is attached/affix below;

Age : ______________
Birthdate : ______________
Birth Place : ______________
Civil Status : ______________

RIGHT
_______________________
SIGNATURE THUMBMARK

That the above-named mentioned has NO VALID ID as of this date.

This certification is issued upon the request of the above-mentioned name for
whatever legal intent it may serve them.

Issued this ________ day of _____________ at Barangay

_____________________________.

___________________
Punong Barangay