Certificate Request Form — Barangay Bolbok

Republic of the Philippines · Province of Batangas

Barangay Bolbok

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

CERT-FORM-001

Rev. 01 · 2026

General Certificate Request Form

Control No.: Date Filed:

Type of Certificate Requested

Barangay Clearance

Certificate of Residency

Certificate of Indigency

Certificate of Good Moral Character

Certificate of Solo Parent

Business Clearance

Certificate of No Pending Case

Others (specify below)

Others / Specify Type of Certificate

Applicant Information

Last Name

First Name

Middle Name

Date of Birth

Age

Civil Status

Contact Number

Years of Residency in Barangay Bolbok

Complete Address in Barangay Bolbok

Purpose of Request

State Purpose

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

Released By / Date

* Processing time varies per certificate type. Bring a valid government-issued ID when claiming.