Republic of the Philippines

City of Cebu
BARANGAY ______________
Office the Barangay Captain

BARANGAY CLEARANCE

This is to certify that name, picture, signature and thumbprint appeared below is a bonafide
resident of this barangay. She/he is of good moral character, a law abiding citizen, and has no
derogatory record on file as of this date.

Full Name:
Address:
Date of Birth:
Place of Birth:
Gender:
Civil Status:
Purpose:

Place of Issue:
Amount Paid:
O.R. No.:
Date of Issue:

___________________________
Right Thumbprint Signature

Not valid without

_______________________________ dry seal
Punong Barangay

“for the wages of sin is death; but the gift of God is eternal life through Jesus Christ our Lord”
-Romans 6:23