Republic of the Philippines

Province of Quezon
Municipality of San Antonio
BARANGAY _____________

OFFICE OF THE PUNONG BARANGAY

CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that _________________, 46 years of age, and a bonafide resident of Purok 6,
Barangay Danahao, San Antonio, Quezon.

This is to certify further that the person above mentioned is a solo/s i n g l e

p a r e n t o r s e p a r a t e d , n o l i v e i n p a r t n e r a n d d o n o t r e c e i v e a n y financial support from
his/her partner.

This is to certify furthermore that she is living with her two (2) children below 18 years
old who’s depending on her support.

This certification is issued upon the request for his/her application for solo parent identification
card purposes. DONE AND ISSUED this 25th day of JUNE 2020 at Barangay ___________, San
Antonio, Quezon.