AUTHORIZATION

The undersigned hereby authorizes MS. *** to process and

receive the following documents at the Phillippine Statistics
Authority (PSA) Office on ***, Monday:

 PSA certified Birth Certificate of:

o (3 copies) ***
o (3 copies) ***.

Also attached herewith is one valid ID of the undersigned.

NAME NAME

Details: Details:

Birthdate: *** Birthdate: ***

Father’s Name: *** Father’s Name: ***..

Mother’s Maiden Name: *** Mother’s Maiden Name: ***

Place of Birth: *** City Place of Birth: ***

Residence: *** Residence: ***

Respectfully,

NAME

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