Republic of the Philippines

LGU Logo
Province of Quezon
Municipality of ___________

CERTIFICATE NON-COHABITATION

TO WHOM IT MAY CONCERN;

This is to certify that CCAM – CFW beneficiary ______________________________ and

________________________________ are ___________________ and bonafide residents of
Barangay_______________________, ________________, Quezon and respectively
belongs to indigent families in our Municipality.

We further certify that ___________________________ and _________________________

as subjects are NOT LIVING IN THE SAME HOUSEHOLD.

This certification is issued upon request of the above named persons for the purpose of
submitting it to DSWD as a requirement for RRP-CCAM thru CFW.

Issued this _______ day of _______________, 2022.

Certified By:

BARANGAY CAPTAIN/CHAIRMAN
(Signature over printed name)

Noted By:

_________________________________
MGGH-MSWDO