Certificate of Residency Form

Republic of the Philippines · Province of Batangas

Barangay Bolbok

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

CR-FORM-001

Rev. 01 · 2026

Certificate of Residency — Request Form

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

Length / Years of Residency

Type of Residency (Owned / Rented / Others)

Purpose of Request

School Enrollment

Employment

Scholarship

Bank / Loan

Government Transaction

Travel Abroad

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 and that I am a bona fide resident of Barangay Bolbok, Batangas City, Batangas. 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

* Processing time: same day (Mon–Fri, 8:00 AM – 5:00 PM). This form is free of charge for indigent residents.