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    Barangay Certificate - Clearance Sample Form

    Uploaded by

    Cher Bee
    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.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd

    Barangay Certificate - Clearance Sample Form

    Uploaded by

    Cher Bee
    25 views1 page
    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.

    Original Title

    Barangay Certificate.Clearance sample form

    Copyright

    © © All Rights Reserved

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    DOCX, PDF, TXT or read online from Scribd

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    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.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    25 views1 page

    Barangay Certificate - Clearance Sample Form

    Uploaded by

    Cher Bee
    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.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    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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