DSWD-SB-GF-091 | REV 00 | 04 MAR 2022

Annex 13: Sample Barangay Certification

BARANGAY CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that _______________________of legal age is a certified resident of

this
(Name of Person/Individual)
Barangay and the specific purpose of securing the Endorsement or Certification is in
relation for his/her application for solicitation permit along charitable or public welfare
purposes for targeted beneficiaries, related to the Disaster Situations/State of National
Emergency or Calamity

This certification is being issued upon the request of the above-named person for the
purpose/s stated above.

Issued this __________ of _______________ 20___, at Barangay ____________

___________________________________
Name and Signature of Barangay Chairman

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DSWD Field Office Caraga, R. Palma Street, Butuan City, Philippines 8600
e-mail: focrg@dswd.gov.ph Tel. Nos. : (085) 342-5619 to 20 Telefax : (085) 815-9173
Website: http://www.caraga.dswd.gov.ph