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Republic of the Philippines

Municipality of Can-avid, Eastern Samar


BARANGAY PANDOL
blgu4pandol1948@gmail.com
blgupandol

OFFICE OF THE PUNONG BARANGAY

CERTIFICATE OF INDIGENCY
TO WHOM IT MAY CONCERN:
PURSUANT to the provision of the Local Government Code, permission hereby granted to herein
applicant as follows:
NAME : _________________________________________
SEX : _________
Passport AGE : _________
BIRTHDAY : __________________________
Size BIRTHPLACE : _________________________________________
CIVIL STATUS : _________
NATIONALITY : _________

REMARKS:
Indigent resident of Barangay Pandol, Can-avid Eastern Samar belongs to our indigent family, He/she
have an income under poverty threshold with minimal means of livelihood that could hardly meet the
family basic needs and has been validate thru NHTS-PR.

THIS CERTIFICATION is being issued upon the


request of the aboved-named person for whatever
legal purpose it may serve him best.
Issued on: ________________ Signature/thumb mark of applicant
Issued at: Brgy. Pandol, Can-avid, Eastern Samar
BSN: 2024-
Issued by:
Duty Officer:
MR. GENER T. CASPE
____________________________
Brgy. Secretary Brgy. Kagawad

Approved by:

HON. DOMINADOR O. GERSIN SR.


Punong Barangay

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