Republic of the Philippines

Province of Leyte
Municipality of San Miguel
Barangay Guinciaman

OFFICE OF THE BARANGAY CHAIRMAN

CERTIFICATION

To Whom It May Concern:

This is to certify that Mr/Ms. , is a resident of

Barangay Guinciaman, Filipino and of legal age. He/She has no enough financial
capacity to support their daily basic needs. With this, Mr/Ms. is one
of the indigent person in our barangay.

This certification is issued upon the request of the interested party for
whatever legal purpose it may serve its best.

Issued on day of 2012 at the office of the Barangay

Captain of Brgy. Guinciaman, San Miguel, Leyte.

Ma. Nilda A. Salomon

Barangay Captain

OR No.:
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