Republic of the Philippines
Province of _________
Municipality of _________
BARANGAY ________________
Office of the Punong Barangay
CERTIFICATION
To Whom It May Concern:
This is to certify that Mr. _____________________________________, _____ years old
and Miss _____________________________________, _____ years old, both Filipino citizens
with residence and postal address at Barangay _______________, Municipality of _________,
Province of __________, are live-in couple.
This certification is issued for all legal intents and purposes.
Issued this _______ day of ___________________________ at Barangay ___________,
Municipality of _________, Province of __________
_____________________
Punong Barangay
Not valid without seal