Republic of the Philippines
Province of Samar
Municipality of San Jose de Buan
BARANGAY CAN-APONTE
OFFICE OF THE PUNONG BARANGAY
CERTIFICATE OF INDIGENCY
TO WHOM IT MAY CONCERN:
THIS IS TO CERTIFY that ROCHELLE M. BAIS of legal age, male/female, single
/ married / widow / widower, Filipino citizen with residence at Barangay Can-Aponte of this
municipality, whose signature appears below is an INDIGENT and that he/she has visibly no
money, property or means of livelihood sufficient and available for daily food and basic
necessities for himself/herself and his/her family.
This Certification is being issued upon the request of the above-named person for
whatever legal purposes it may serve him/her.
Issued this 6th day of June, 2025 at Barangay Can-Aponte, San Jose de Buan, Samar,
Philippines.
ROCHELLE M. BAIS
Signature Over Printed Name
BEATRIZ P. EBIAS
Punong Barangay
Amount Paid: __________
O.R. Number: __________
Date: __________
“NOT VALID WITHOUT OFFICIAL SEAL. NOT VALID WITHOUT OFFICIAL RECEIPT”
Republic of the Philippines
Province of Samar
Municipality of San Jose de Buan
BARANGAY CAN-APONTE
OFFICE OF THE PUNONG BARANGAY
CERTIFICATE OF INDIGENCY
TO WHOM IT MAY CONCERN:
THIS IS TO CERTIFY that REYNA M. BAIS of legal age, male/female, single /
married / widow / widower, Filipino citizen with residence at Barangay Can-Aponte of this
municipality, whose signature appears below is an INDIGENT and that he/she has visibly no
money, property or means of livelihood sufficient and available for daily food and basic
necessities for himself/herself and his/her family.
This Certification is being issued upon the request of the above-named person for
whatever legal purposes it may serve him/her.
Issued this 6th day of June, 2025 at Barangay Can-Aponte, San Jose de Buan, Samar,
Philippines.
REYNA M. BAIS
Signature Over Printed Name
BEATRIZ P. EBIAS
Punong Barangay
Amount Paid: __________
O.R. Number: __________
Date: __________
“NOT VALID WITHOUT OFFICIAL SEAL. NOT VALID WITHOUT OFFICIAL RECEIPT”