REPUBLIC OF THE PHILIPPINES

PROVINCE OF ZAMBOANGA DEL SUR

MUNICIPALITY OF TAMBULIG
BARANGAY__________
CERTIFICATE OF LIVE BIRTH
NAME OF CHILD: _________________________________________________________
FIRST NAME MIDDLE NAME LAST NAME
GENDER: _______________DATE OF BIRTH: __________________TIME OF BIRTH: _______
PLACE OF BIRTH: ________________________________________
TYPE OF BIRTH: _______________________ BIRTH ORDER: _____________
WEIGHT AT BIRTH: ________________(GRAMS) RELIGION: ________________
TOTAL NUMBER OF CHILDREN BORN ALIVE: ______
NO. OF CHILDREN STILL LIVING INCLUDING THIS BIRTH: __________
NO. OF CHILDRENN BORN ALIVE BUT ARE NOW DEAD: _____________
NAME OF MOTHER (MAIDEN): _______________________________________________
FIRST NAME MIDDLE NAME LAST NAME

OCCUPATION: _________________ AGE THE TIME OF BIRTH: _______________

RESIDENCCE: _______________________________________________________
PUROK BARANGAY PROVINCE
NAME OF FATHER: ________________________________________________________
FIRST NAME MIDDLE NAME LAST NAME

RELIGION: ____________ OCCUPATION: ______________AGE AT THE TIME OF BIRTH: _______

DATE OF MARRIAGE OF PARENTS: _________________ PLACE OF MARRIAGE: ______________

ATTENDANT AT BIRTH: NAME: ___________________

POSITION: ________________
INFORMANT: NAME: _____________________
ADDRESS: __________________
RELATIONSHIP TO THE CHILD: ________________

PREPARED BY: VERIFIED BY:

____________________________ ________________________
BARANGAY SECRETARY BARANGAY CAPTAIN