CRG Form No.

101
(Revised January 1993)

(To be accomplished in triplicate)

Republic of the Philippines

CERTIFICATE OF FOUNDLING
Province ____________________________________________________
City / Municipality _____________________________________________
1. NAME

2. SEX

3. AGE WHEN FOUND

C
H
I
L
D

Registry No.

4. DATE AND TIME WHEN FOUND

5. PLACE WHERE FOUND

6. COLOR OF THE EYES

7. COLOR OF THE HAIR.

8. DISTINCT BODY FEATURES OR MARKS

9. CONDITION OF THE CHILD WHEN FOUND

F
I
N
D
E
R
I
N
F
O
R
M
A
N
T

10. Name _________________________________________________________________________

Address _______________________________________________________________________
Telephone No. (if any) ______________________ Occupation ___________________________
11. Name _________________________________________________________________________
Address _______________________________________________________________________
Telephone No. (if any) _______________________ Occupation __________________________
12. CERTIFICATION
This is to certify that the information given above are true and correct to my own knowledge and belief.

__________________________________
(Signature of informant)

Community Tax No. ___________________

Date Issued _________________________
Place Issued ________________________
SUBCRIBED AND SWORN to before me this ___________ day of _______________,
____________ at _______________________________________________, Philippines.

__________________________________
(Signature over printed name of the Civil
Registrar)
C
I
V
I
L
R
E
G
I
S
T
R
A
R

13. CERTIFICATION OF THE CIVIL REGISTRAR

This is to certify that the foundling herein named is reported to this Office for registration on
________________________________________ and properly recorded in the Register of Foundling.

_______________________________________
(Signature over printed name of the Civil Registrar)