Indigency Form

Republic of the Philippines
Province of Zamboanga Del Norte

City of Dipolog
Barangay Biasong
OFFICE OF THE PUNONG BARANGAY
CERTIFICATE OF INDIGENCY
TO WHOM IT MAY CONCERN;
THIS IS TO CERTIFY that ________________________ is a bona

fide resident of _________________, Biasong, Dipolog City, and
he/she is known to me as person of good moral character.
That ____________________ has no means of livelihood and is

considered in Barangay Biasong as INDIGENT.
ISSUED upon request of ____________________________________

______________________ for whatever legal purpose it may serve
him/her best.
Given this _____ day of ____________ year ______, Biasong,

Dipolog City.
HON. FLORENDA R. AGUSTIN

Punong Barangay
City of Dipolog
Barangay Biasong
CERTIFICATION
THIS IS TO CERTIFY that MYROSE L. CAPITO is a member of

the Pantawid Pamilyang Pilipino Program (4Ps) in Barangay Turno,
Dipolog City.
Further, she wishes to transfer her 4Ps membership from

Barangay Turno, Dipolog City, to Barangay Biasong, Dipolog City,
where she and her family currently reside.
ISSUED upon request of the above-named person for whatever

legal purpose it may serve her best.
Given this 5th day of December year 2017, Biasong, Dipolog

City.
HON. GOMERCINDO C. CALAGUI, SR.

Punong Barangay
City of Dipolog
Barangay Biasong
PERMIT
PERMIT IS HEREBY GRANTED to Dr. Mario Mopon Family Medical

Clinic and Bluedragon Pharmaceutical Training sponsors to conduct
Free Blood Sugar Screening on December 30, 2012, to be held at
corner Lopez Jaena and Gonzales Streets, Biasong, this City.
This permit takes effect on December 30, 2012, within the

jurisdiction of Barangay Biasong, Dipolog City.
Given this 18th day of December year 2012, Biasong, Dipolog

City.
Hon. GOMERCINDO C. CALAGUI, Sr.

Punong Barangay
City of Dipolog
Barangay Biasong
OFFICE OF THE BARANGAY CHAIRMAN
CERTIFICATION
THIS IS TO CERTIFY that GEORGE VINCENT D. LIBAO is a

resident of Padre Gomez Street, Biasong, Dipolog City since birth
up to the present date. He is known to me as person with good
moral character.
That GEORGE VINCENT D. LIBAO was born on December 19, 2003

and is currently studying as Grade IX student at Saint Vincent’s
College Annex, Dipolog City.
ISSUED upon request of JORGINA D. LIBAO, mother of the

above-named person, for whatever legal purpose it may serve her
best.
Given this 22nd day of December year 2017, Biasong, Dipolog

City.

PUNONG BARANGAY
Province of Zamboanga del Norte
City of Dipolog
Barangay Biasong
CERTIFICATION
THIS IS TO CERTIFY that a hearing was conducted by the

undersigned between Juliet Benerado Antig (Complainant) and
(Respondents) Erlinda Tabancura/representative (Dennis
Tabancura), Luzelli Patangan, Eddie Tabancura, Cecilia
Tabancura/representative (Adam Malik Tabancura) and Andresa
Tabancura on January 5, 2017 at 10:00 o’clock in the morning at
the Barangay Hall for Barangay Case No. KP-17-01 for
Confrontation per attached summon.
ISSUED upon request of Juliet B. Antig for whatever legal

purpose it may serve her best.
Given this 5th day of January year 2017, Biasong, Dipolog

City.

Punong Barangay
City of Dipolog
Barangay Biasong
CERTIFICATION
THIS IS TO CERTIFY that the following persons were not

revalidated by the enumerators from the Department of Social
Welfare and Development thru the NHTS-PR due to the reason that
some have transferred or were not located in Barangay Biasong,
Dipolog City.
Transferred:
1. Montallana, Nestor de Guzman
2. Javierto, Joel Cabrera
3. Montano, Rolando Sumagop
4. Rivera, Roberto Cuadro
5. Calago, Ronie Anoile
6. Paluray, Felisiano Cardlo
7. Tubongbanua, Remedios Constantino
8. Edaga, Reny Yurong
9. Catcharo, Binito Mistoso
10. Gabuya, Marlon Centino
11. Salatan, Luzminda Lagata
12. Ruiz, Arnold dela Cruz
13. Ogoc, Rizaldy Alajas
14. Mosteral, Faisal Ejerol
15. Collado, Antonio
Unable to Locate:
1. Pabodabo, Fe Barte
2. Ambato, Pablito Umbog
3. Velasco, Rodridgo Baret
4. Jawadil, Misuari Calalon
5. Ballano, Julito Andata
6. Cinda, Raul Bagelisa
7. Gomez, Narciso Cezar
8. Ariola, Rosie
9. Ronquillo, Agrepina Ruiz
10. Cordua, Grispina Elcamel
11. Roca, Mary Hipulan
12. Atad, Jerry Daquipel
13. Saddalani, Bakrin Pakinula
14. Randes, Gabriel Lumamba
15. Acama, Flory Encoy
16. Cornelio, Anthony Zamoras
17. Imbang, Reina Juanod
18. Loria, Edgardo Malabanan
19. Baluma, Rosie Solatorio
20. Ambrosia, Lorenzo Gahum
21. Jacinto, Tristan Boy Teodoro
22. Pregoner, Roel Columnas
23. Paloray, Jinny Ellonor
24. Enderez, Genoviva Caniete
25. Elumbaring, Garpar Fuentes
ISSUED this 25th day of April 2012, Barangay Biasong,

Dipolog City.

Punong Barangay
City of Dipolog
Barangay Biasong
CERTIFICATION
THIS IS TO CERTIFY that MELVIN T. DY is the owner of

Wateree Purified Drinking Water located in Osmeña Street corner
Mabini Street, Biasong, Dipolog City.
This is to certify further that per statement of MELVIN T.

DY, he has a monthly gross income of thirty-seven thousand five
hundred pesos only (P37,500.00) derived from the said business.
ISSUED upon request of the above-named person for whatever

legal purpose it may serve him best.
Given this 22nd day of February year 2018, Biasong,

Dipolog City.

Punong Barangay

City of Dipolog
Barangay Biasong
CERTIFICATION
THIS IS TO CERTIFY that based on the records in this

barangay, a certain business enterprise JAN LENDING was not
listed in our Barangay Business Clearance Logbook which means
that the said business was not registered in the barangay nor
paid the amount required for its Barangay Permit for legal
operation.
This certification is issued upon request of Atty.

Uldarico M. Mejorada II, Counsel of MR. Romel Comandante, for
whatever legal purpose it may serve him best.
Given this 14th day of June year 2018, Biasong, Dipolog

City.

Punong Barangay
City of Dipolog
Barangay Biasong
THIS IS TO CERTIFY that ROLANDO T. REGENCIA, JR., single,

is a bona fide resident of Purok 8, Biasong, Dipolog City, and an
INDIGENT CITIZEN of the barangay.
This certifies further that the above named person is known

to be a person having good moral character and a law-abiding
citizen of the community.
ISSUED upon request of the above-named person to support his

application for Special Program for Employment of Student of
DOLE.
Given this 16TH day of April year 2018, Biasong, Dipolog

City.

Punong Barangay
City of Dipolog
Barangay Biasong
THIS IS TO CERTIFY that MARK L. LACQUIO is a bona fide

resident of Calibo Street, Biasong, Dipolog City, and he/she is
an Indigent Citizen of this barangay.
This certifies further that the above person is known to be

a person having a good moral character and a law-abiding citizen
of the community.
This certification is issued upon request of MARK L. LACQUIO

to support his/her application for Special Program for Employment
of Student of DOLE.
Given this 9TH day of May year 2017, Biasong, Dipolog City.

Punong Barangay

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Republic of the Philippines

Province of Zamboanga Del Norte

OFFICE OF THE PUNONG BARANGAY

TO WHOM IT MAY CONCERN;

THIS IS TO CERTIFY that ________________________ is a bona

That ____________________ has no means of livelihood and is

ISSUED upon request of ____________________________________

Given this _____ day of ____________ year ______, Biasong,

HON. FLORENDA R. AGUSTIN

OFFICE OF THE PUNONG BARANGAY

TO WHOM IT MAY CONCERN;

THIS IS TO CERTIFY that MYROSE L. CAPITO is a member of

Further, she wishes to transfer her 4Ps membership from

ISSUED upon request of the above-named person for whatever

Given this 5th day of December year 2017, Biasong, Dipolog

HON. GOMERCINDO C. CALAGUI, SR.

OFFICE OF THE PUNONG BARANGAY

PERMIT IS HEREBY GRANTED to Dr. Mario Mopon Family Medical

This permit takes effect on December 30, 2012, within the

Given this 18th day of December year 2012, Biasong, Dipolog

Hon. GOMERCINDO C. CALAGUI, Sr.

OFFICE OF THE BARANGAY CHAIRMAN

TO WHOM IT MAY CONCERN;

THIS IS TO CERTIFY that GEORGE VINCENT D. LIBAO is a

That GEORGE VINCENT D. LIBAO was born on December 19, 2003

ISSUED upon request of JORGINA D. LIBAO, mother of the

Given this 22nd day of December year 2017, Biasong, Dipolog

Hon. GOMERCINDO C. CALAGUI, Sr.

OFFICE OF THE PUNONG BARANGAY

TO WHOM IT MAY CONCERN;

THIS IS TO CERTIFY that a hearing was conducted by the

ISSUED upon request of Juliet B. Antig for whatever legal

Given this 5th day of January year 2017, Biasong, Dipolog

Hon. GOMERCINDO C. CALAGUI, Sr.

OFFICE OF THE BARANGAY CHAIRMAN

TO WHOM IT MAY CONCERN;

THIS IS TO CERTIFY that the following persons were not

ISSUED this 25th day of April 2012, Barangay Biasong,

Hon. GOMERCINDO C. CALAGUI, Sr.

OFFICE OF THE BARANGAY CHAIRMAN

TO WHOM IT MAY CONCERN;

THIS IS TO CERTIFY that MELVIN T. DY is the owner of

This is to certify further that per statement of MELVIN T.

ISSUED upon request of the above-named person for whatever

Given this 22nd day of February year 2018, Biasong,

HON. GOMERCINDO C. CALAGUI, SR.

Republic of the Philippines

OFFICE OF THE PUNONG BARANGAY

TO WHOM IT MAY CONCERN;

THIS IS TO CERTIFY that based on the records in this

This certification is issued upon request of Atty.

Given this 14th day of June year 2018, Biasong, Dipolog

HON. GOMERCINDO C. CALAGUI, SR.

OFFICE OF THE PUNONG BARANGAY

TO WHOM IT MAY CONCERN;

THIS IS TO CERTIFY that ROLANDO T. REGENCIA, JR., single,

This certifies further that the above named person is known

ISSUED upon request of the above-named person to support his

Given this 16TH day of April year 2018, Biasong, Dipolog

Given this _ day of __ year , Biasong,