Republic of the

BIRTHDATE: Philippines
JAN.15, 1995
Province of Bataan
BIRTHPLACE: CAINTA
City of Balanga
RIZAL Barangay Talisay
RELIGION:
OFFICE OF THE CATHOLIC
PUNONG BARANGAY
BLOOD TYPE:
NATIONALITY: FILIPINO

_________________________
Signature of Member

IN CASE OF EMERGENCY:
Name: ERLITA F. PIZARRA
JERICK FELICIANO PIZARRA
Address: #46 J.P, Rizal Talisay, City
BRGY. ID. NO. 20-024
of Balanga, Bataan
Cp #/Tel #: 0926-626-3026
This is to certify that the person,
whose picture appear hereon, is
resident in this Barangay Talisay
Balanga City, Bataan.
______________________________
2024-2025
TERESITO REMO O. CAMACHO
PUNONG BARANGAY