Republic of the Philippines Philippine Statistics Authority OFFICE OF THE CIVIL REGISTRAR GENERAL Revi sAtin Foes‘ cant caTe Pane PANT ters bw sec red Pons CHEK) ape bot 2 Resta le veqlted tom eer oe 3 an aunarenton tion ha acumen oer vith he 0 he requester ae oaaed Roqustior [] BIRTH CERTIFICATE AUTHENTICATION cou Number of copies: Clone EF] two mers (Specty) 2 arance No. LELI- ps Reh ae eee a a enc Reni ere Lal eae] LL Lasse Peder Get your PSA certificates online! Request at wwww.psaserblis.com.ohPORPOSE: Graces ona ard Gheck 7) appropriate box TL] cieensenetisy teen (-] Eroieymant (ca) Ly setoe!Reauirements Ey Posspen Tavet (Soecty County: ___') 1] there Sony: 1 Emotoiment road) (Spec County) "REQUESTER'S INFORMATION Last Name, Fiat Name mu. Maing Adress Cty Munipatty Province ‘Cora Cre ett tetap NOTICE ‘The PSA supports he soy of the State 19 protect Be undamertal ight of privacy In ew of the passage of ‘Repubite Act No. 10173 ato K2own as” Data Privacy Act of 2042" tus fice caret faun Socuer fom sw edine aonty ofan ndvisun apparent orn be assay an rey ascertain ow coment ‘be inradua! wove persona lommaton = processed. Suh consent. mut be evidenced by wren, ‘lsctronie or ecordee means Hance, orginal and cred re copy of Carseat of vw of Binh, Conical of Mariage ond Coricata of Dea, ‘nd Gereate of No Mariage (CENOMAR) and Avr on Manlages can on be snd 1 The omar hers or rough a dy authorized eprnaniae: 2 fra spouse, parent, rect doxconcants guaran or atten legally charge of ier, # minor '3. The cour or proper pubic ofa whenever abeoliely necessary adrinsrate jude or Ober ofa proceedings detrnine the nt ofa paron 4 hncase ofthe persons deat, the neers! of | understand that a8 per Data Privacy Act of 2012. PEA documents favaable ns oes, cannot be released {be without wall [x/government.nsued IDs and proper authorization Kom the owner of he hshher parent minor), hisiber” spouse, hater ect descendant, of hisher autores ‘duardaninettuionsn-charge Gores oe Region DISCLAIMER PSA tents have te option to scur cation an coy of regi document in ay of PSS accredited ‘banners. Theee parners may exioné thor sorens Buch dovery othe requesiag documents tyeugh Patt |Bitorzedcoutore. Ary problem encoutered in th Yarsacion wit he pares beyond he expanse PSR