Republic of the Philippines

Province of Negros Oriental

Municipality of _______________
Barangay ___________________

OFFICE OF THE PUNONG BARANGAY

BARANGAY CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that ________________________________, of legal age,

Filipino, is known to me as resident of_____________________________.

However as of _____________, Mr/Ms/Mrs. ________________________

can no longer be located in the area and reported to have transferred

residence/locked down as vouched by a neighbor/Day Care Worker/Brgy

official/Barangay Health Worker/Officer of Senior Citizen Association.

This certification is being issued for whatever purpose this may serve.

Issued this ___________________in _________________________.

Signed:

__________________________
Punong Barangay