OCRG Form No.

101 (To be accomplished in triplicate using black ink)

(Revised August 2021) Republic of the Philippines
OFFICE OF THE CIVIL REGISTRAR GENERAL
CERTIFICATE LIVE BIRTH
Registry No.
Province

City/Municipality
1. NAME (First) (Middle) (Last)

2. SEX (Male/Female) 3. APPROXIMATE AGE 4. DATE WHEN FOUND 5. TIME WHEN FOUND 6. APROXIMATE
WHEN FOUND (Day) (Month) (Year) DATE OF BIRTH
(Day) (Month) (Year)

C
H (House No., St., Barangay) (City/Municipality) (Province)
7. PLACE WHERE FOUND
I
L
D
8. COLOR OF THE EYES 9. COLOR OF THE HAIR 10. DISTINCT BODY FEATURES OR MARKS

11. CONDITION OF CHILD WHEN FOUND 12. CITIZENSHIP OF THE CHILD

Healthy with Health Issues

13. NAME (First) (Middle) (Last)

F
I
14. SEX (Male/Female) 15. AGE (completed years) 16. PHONE / EMAIL 17. OCCUPATION
N
D
E
(House No., St., Barangay) (City/Municipality) (Province)
R 18. RESIDENCE

(First) (Middle) (Last)

I 19. NAME
N
F
O 20. SEX (Male/Female) 21. AGE (completed years) 22. PHONE / EMAIL 23. OCCUPATION
R
M
A 24. RESIDENCE (House No., St., Barangay) (City/Municipality) (Province)
N
T

25. CERTIFICATION OF INFORMANT

THIS IS TO CERTIFY that the information given above are true and correct to my own knowledge and belief.

Signature Over Printed Name of the Informant

SUBSCRIBED AND SWORN to before me this day of , at

, Philippines, affiant who exhibited to me his/her Community Tax Certificate or any government issued ID

issued on at .

Signature of the Administering Officer

26. PREPARED BY
Name in Print

Signature Over Printed Name

Position / Title / Designation

Title or Position

Address
Date

27. RECEIVED BY 28. REGISTERED AT THE OFFICE OF THE CIVIL REGISTRAR

Signature Over Printed Name Signature Over Printed Name

Title or Position Title or Position

Date Date

REMARKS/ANNOTATIONS (For LCRO/OCRG Use Only)