Republic of the Philippines

Province of Samar
Municipality of Basey
BARANGAY SULOD

OFFICE OF THE PUNONG BARANGAY

CERTIFICATION

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that Mercurio Nanquil Froilan, 85 years old, Filipino,

Male, Married and a resident of this barangay has passed away on July 24, 2019 at
7 0’clock in the morning.

CERTIFIES FURTHER that the above-named deceased person is personally

known by the undersigned to be of good moral standing in the community and has
been residing at this barangay for so many years prior to her demise.

THIS CERTIFICATION is issued being to the bereaved family of the above-

named deceased person for the Registration of Death, Death Benefit Claims,
Insurance Claims and other legal purposes this may serve and shall be considered
null and void if used in any unlawful transaction.

GIVEN this 30th day of July 2019 at Brgy.Sulod, Basey, Samar.

HON. NOEL ADEL O. LABNAO

Punong Barangay

Signature:

_____________________

CTC #: 29733109
Issued on: 7/30/2019
Issued at: Brgy. Sulod, Basey, Samar

OR #: 2911402
Issued on: 7/30/2019