BARANGAY CERTIFICATE

This is to certify that

(Surname) (First Name) (Middle Name)

age , residing at ,
(Complete Address – Purok, Barangay, City/Municipality, Province)

is tilling the following crop(s): as

(owner/tenant/lessee/others – specify)

at with size hectares

(Farm Location – Barangay, City/Municipality, Province)

since / / .
(Month) (Day) (Year)

This certification is being issued by the Barangay solely for the purpose of the farmers and
fisherfolk registration to the Registry System for Basic Sectors in Agriculture (RSBSA) of the
Department of Agriculture, and may not be issued for other purposes not mentioned above.

____________________________________________________________ _________________________
Name and Signature of Barangay Chairman Date

____________________________________________________________
Barangay

____________________________________________________________
City/Municipality

Name and Signature of Farmer/Fisherfolk Name and Signature of Neutral Third

Party Witness

Date Date