Republic of the Philippines

Province of Samar
MUNICIPALITY OF CALBIGA
BARANGAY TIMBANGAN

Office of the Punong Barangay

Barangay certification
TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY THAT the person whose name and photo appear
below was born in this Barangay and whose facts of birth as follows:

Full Name : ______________________________

Sex : ______________________________
Date of Birth : ______________________________
Residence : ______________________________
Name of Father : ______________________________
Name of Mother (Maiden): _________________________

THIS CERTIFICATION IS ISSUED upon the request of

_____________________________ for the purpose of delayed registration of birth
of _____________________________.

GIVEN this ______ day of ______________, 202__ at the Office of the

Punong Barangay of Barangay Timbangan, Calbiga, Samar, 6715, Philippines.

O.R.# : ______________
Amount : ______________ NERISSA G. MENDAÑO
Date : ______________ Barangay Secretary

HON. JAIME S. ABANTAO

Punong Barangay