REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF INTERIOR AND LOCAL GOVERNMENT

OFFICE OF THE PUNONG BARANGAY
BARANGAY CAINGAL, SAN CARLOS CITY, PANGASINAN

BARANGAY CLEARANCE CERTIFICATION

This is to certify that the person whose photo, signature, and thumbprint appear herein is a
bonafide resident of this barangay. He/She is of good moral character, a law abiding citizen,
and has no category record on file as of this date.

Full Name : ________________________________________

Address: ________________________________________
Date of Birth: ________________________________________
Place of Birth: ________________________________________
Gender ________________________________________
Age: ________________________________________
Civil Status: ________________________________________
Purpose: ______________________________________________
Date Of Issue: ______________________________________________

2x2
Picture

Signature
Right Thumbmark

HON. GILDO C. CASTRO NOTE: NOT VALID WITHOUT

Punong Barangay THE BARANGAY DRY SEAL

“For the wages of sin is death, but the free gift of God is eternal life through Jesus Christ our
Lord.”
-Romans 6:23-