OFFICE OF THE BARANGAY CAPTAIN

CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify under oath that_____________, a resident ____________________________is

no longer living together with his wife, ______________for almost twenty five years (25).

It is of public knowledge in our barangay that ______________has been separated in fact from
his legitimate spouse due to the fault of the latter by having a paramour during their marriage. Thus,
such incident leads to their separation.

This certification is being issued upon the request of the above-named person for whatever legal
purpose it may serve.

Issued this___ day of February, 2020__________________, Philippines.

PUNONG BARANGAY