Republic of the Philippines

Department of Education
Region VIII
Sta. Margarita I District
PANARUAN ELEM. SCHOOL
Sta. Margarita

PARENT DECLARATION OF DATE OF BIRTH

S.Y.: __________________________

To Whom This May Concern:

I/ We hereby certify that our/my child ____ ____

( Name of Child)

Was born on at
to
(Date of Birth) ( Place of Birth)

_____ __________________ ________________________________

( Name of Father ) (Name of Mother)

I/ We hereby request that our/my child be accepted to enrol in this school meanwhile that

I/we are still working on his or her birth certificate.

____________________________________
(Signature of Parent)

Witness/es:

_________________________________ ____________________________________