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Barangay Certificate - Clearance Sample Form

The document is a certification from a barangay in the Philippines providing details about a 10-year-old girl for her second dose vaccination, including her name, birthdate, and that her aunt is her guardian.

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Cher Bee
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445 views1 page

Barangay Certificate - Clearance Sample Form

The document is a certification from a barangay in the Philippines providing details about a 10-year-old girl for her second dose vaccination, including her name, birthdate, and that her aunt is her guardian.

Uploaded by

Cher Bee
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Republic of the Philippines

Province of Leyte
Municipality of Dulag
BARANGAY CABACUNGAN

-o0o-

OFFICE OF THE PUNONG BARANGAY

BARANGAY Certification
TO WHOM IT MAY CONCERN:

This is to certify that Aisha Santana D. Malquisto, 10 years of age, born


July 22, 2011, female/male, single/married/widow, and a resident of Barangay
Cabacungan Dulag, Leyte.

This is to further certify that the guardian of the above mentioned name is
her Auntie, Shiena Marie A. Malquisto.

This certification is being issued upon the request of interested party to


assist the above-mentioned name on her second dose vaccination.

Given this 24th of June, 2022 at Brgy. Cabacungan Dulag, Leyte.

JOEDY P. YEPEZ
Barangay Chairman
O.R. No.:
Cert/Clearance Fee:
Date Issued:
Amount: ₱

Not Valid Without Seal

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