Barangay Clearance Form — Barangay Bolbok

Republic of the Philippines · Province of Batangas

Barangay Bolbok

Batangas City, Batangas · Tel: 043 980 0831 · contact@bolbok.gov.ph

BC-FORM-001

Rev. 01 · 2026

Barangay Clearance

Control No.: Date Filed:

Applicant Information

Last Name

First Name

Middle Name

Date of Birth

Place of Birth

Civil Status

Nationality

Contact Number

Complete Address in Barangay Bolbok

Years of Residency

Precinct Number

Purpose of Request

Employment

Bank / Loan

Business Permit

Travel Abroad

Government Transaction

School / Scholarship

Legal Purpose

Others (specify below)

Others / Specify

Valid ID Presented

Type of ID

ID Number

I hereby certify that all information stated above is true and correct to the best of my knowledge. Any false declaration shall subject me to applicable penalties under existing laws.

Applicant's Signature over Printed Name

Date: __________________________

Punong Barangay / Authorized Official

Barangay Bolbok, Batangas City

For Office Use Only

OR Number

Amount Paid

Received By

* This is a request form. The actual Barangay Clearance certificate will be issued by the Barangay Hall after verification. Processing time: same day (Mon–Fri, 8:00 AM – 5:00 PM).