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Barangay Indigency Form

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Republic of the Philippines

OFFICE OF THE PUNONG BARANGAY

Certificate of Indigence
This is to certify that __________________________________________________ of legal
age, is a resident of _________________________________________.

Further certifies that he/she belongs to an indigent family which has proven to be below the
poverty line.

This certification is issued upon request for availing of:

 Medical Assistance
 Financial Assistance
 Educational Assistance
 Burial Assistance
 Employment Assistance
 General Purpose

and for whatever legal matters it may serve best.

Issued this __________ day of _________________, 2023 at __________________

___________________________________
Punong Barangay

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