Republic of the Philippines

Province of Antique
Municipality of Tobias Fornier
Barangay Barasanan A

OFFICE OF THE PUNONG BARANGAY

TRAVEL CLEARANCE CERTIFICATE FOR A MINOR

The Office of Barangay Barasanan A poses no objection to the travel of AMAYA KATE
A. ASENJO born on April 30, 2011 of Barasanan A, Tobias Fornier, Antique who is a daughter
of Mr. Lemuel L. Asenjo and Mrs. Darlyn A. Asenjo of Barasanan A, Tobias Forier, Antique.

This certification is based on the favorable evaluation of the purpose of the minor’s travel
outside of the province who is hereby permitted to travel under the care of her Aunt MS. PEARL
JOY ASENJO.

This will be valid for the period of one year provided the conditions under which this
certificate was issued have not changed.

JOSE NELSON O. LAURIO

Punong Barangay