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DSWD-SB-GF-091 | REV 01 | 03 OCT 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 Central Office, IBP Road, Batasan Pambansa Complex, Constitution Hills, Quezon City, Philippines 1126
Website: http://www.dswd.gov.ph Tel Nos.: (632) 8 931-8101 to 07 Telefax: (632) 8 931-8191

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