Republic of the Philippines

Province of _____________
Municipality of ____________
Barangay ___________

CERTIFICATE OF INDIGENOUS PEOPLES MEMBERSHIP

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that the spouses ________________________________,

married to former ______________________________, maternal grandparents of
________________________________, are known to be an authentic member of the IBANAG
Indigenous Peoples/Indigenous Cultural Communities (IPs/ICCs) and whose place of origin was
traceable at _____________, ________________, ______________.

Further certify that __________________, is also a legitimate member of the Indigenous

Peoples belonging to the IBANAG IP/ICC of _____________, ___________, _____________.

This Certificate of Indigenous Peoples membership is issued upon request of

__________________, for whatever purpose it may best serve him.

Issued this ____ day of ___________ 2021 at __________, ____________,

____________, Philippines.

______________________

IP Leader