Republic of the Philippines
Province of __________________
MUNICIPALITY OF ________________
BARANGAY ___________________
OFFICE OF THE PUNONG BARANGAY
BARANGAY CLEARANCE
TO WHOM IT MAY CONCERN:
This is to certify that the bearer hereof ______________________________________ is
a resident of this barangay and is personally known to me to be a person of good moral character
and of a reputable social standing in the community.
That he/she has no pending charges under investigation to date by the Lupong
Tagapamayapa (Barangay Justice) nor convicted of any crime or misdemeanor whatsoever as per
available record kept in this office.
This certification is being issued upon the request of ___________________________
for “_____________________”.
Given this ________ day of ________________, 2013 at Barangay _______________,
_____________, _______________, Philippines.
__________________
Barangay Captain
____________________________
Bearer’s Signature
CTC No. _____________________
Issued on _____________________
Issued at _____________________