FILL IN ALL BLANK SPACES.

BARANGAY CERTIFICATION

This is to certify that is a resident of

(Complete name of Applicant)

Negros Occidental.
(Barangay) (City/Municipality)

This further certifies that he/she is the son/daughter of ,

(Parent's Name)

whose TOTAL ANNUAL INCOME is ₱ and that he/she is

(Occupation)

a person of good moral character and has no derogatory record as far as this city/municipality is concerned.

Witness my signature this of , 20 .

Signature over Printed Name of Punong Barangay

Contact Number:

SCHOOL CERTIFICATION

This is to certify that is a

(Complete name of Applicant)

Please check one:

Grade 12 student SHS graduate College Student
(Indicate Course and Year Level)

of for School Year

(Name and Address of School)

He/She is a student of good moral character and has no pending case in our school.

Witness my signature this of , 20 .

Signature over Printed Name of Principal/College Dean

Contact Number:

Note: Certification must be issued from last school attended.

PARENT/GUARDIAN CERTIFICATION

This is to certify that is a resident of

(Complete name of Applicant)

Negros Occidental.
(Barangay) (City/Municipality)

has not availed of any local, national or foreign scholarship for college education before this application.

This further certifies that no other member of the family up to the fourth civil degree of consanguinity (brother/sister, uncle/aunt,
nephew/niece, first cousin) has availed of any Scholarship Program of the Provincial Government.

Affixed is my signature this day of , 20 at , Philippines.

(City/Municipality)

Signature over Printed Name of Parent/Guardian

Contact Number: