BARANGAY REGISTRY

Name: ______________________________________________________________________________________________________
Present Address: ______________________________________________________________________________________________
Provincial Address: ____________________________________________________________________________________________
Birth Date: ___________________________________________________________________________________________________
Birth Place: __________________________________________________________________________________________________
Gender: _____________________________________________________________________________________________________
Civil Status: __________________________________________________________________________________________________
Citizenship: __________________________________________________________________________________________________
Occupation: __________________________________________________________________________________________________
Household Members:

Name Date of Age Status Gender Educational Occupation

Birth Attainment

I hereby certify that the above information are true and correct to the best of my knowledge.
___________________________
SIGNATURE
Attested by:
__________________________________
Barangay Secretary

BARANGAY REGISTRY
Name: ______________________________________________________________________________________________________
Present Address: ______________________________________________________________________________________________
Provincial Address: ____________________________________________________________________________________________
Birth Date: ___________________________________________________________________________________________________
Birth Place: __________________________________________________________________________________________________
Gender: _____________________________________________________________________________________________________
Civil Status: __________________________________________________________________________________________________
Citizenship: __________________________________________________________________________________________________
Occupation: _________________________________________________________________________________________________
Household Members:

Name Date of Age Status Gender Educational Occupation

Birth Attainment

I hereby certify that the above information are true and correct to the best of my knowledge.
___________________________
SIGNATURE

Attested by:
__________________________________
Barangay Secretary