Revised as of 16 June 2021

Barangay Certificate Number:

_______________________

BARANGAY CERTIFICATION
(First Time Jobseekers Assistance Act - RA 11261)

This is to certify that Mr./Ms._____________________________, a resident of

_________________________________________________ (complete address)
for ____ years/months, is a qualified availee of RA 11261 or the First Time
Jobseekers Assistance Act of 2019.

I further certify that the holder/bearer was informed of his/her rights, including the
duties and responsibilities accorded by RA 11261 through the Oath of Undertaking
he/she has signed and executed in the presence of Barangay Official/s.

Signed this _____ day of ___________________, 20____, in the

City/Municipality of ______________________________________________.

This certification is valid only until ____________, one (1) year from the issuance.

________________________________
Punong Barangay/
Authorized Barangay Official and Position

________________________________
Date

Witnessed by:

________________________________
Barangay Official/Designation/Position

________________________________
Date
THIS FORM NEED NOT BE NOTARIZED RA

11261 Form 1