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CRG Form No. 101 (To be accomplished in triplicate)(Revised January 1993)

Republic of the PhilippinesCERTIFICATE OF FOUNDLING

Province ____________________________________________________City / Municipality _____________________________________________

Registry No.

1. NAME 2. SEX

3. AGE WHEN FOUND 4. DATE AND TIME WHEN FOUND

5. PLACE WHERE FOUND

6. COLOR OF THE EYES 7. COLOR OF THE HAIR.

8. DISTINCT BODY FEATURES OR MARKS

CHILD

9. CONDITION OF THE CHILD WHEN FOUND

FINDER

10. Name _________________________________________________________________________

Address _______________________________________________________________________

Telephone No. (if any) ______________________ Occupation ___________________________

INFORM

ANT

11. Name _________________________________________________________________________

Address _______________________________________________________________________

Telephone No. (if any) _______________________ Occupation __________________________

12. CERTIFICATION

This is to certify that the information given above are true and correct to my own knowledge and belief. __________________________________

(Signature of informant)Community Tax No. ___________________Date Issued _________________________Place Issued ________________________

SUBCRIBED AND SWORN to before me this ___________ day of _______________, ____________ at _______________________________________________, Philippines.

__________________________________(Signature over printed name of the Civil

Registrar)CI

VIL

REGI

STR

AR

13. CERTIFICATION OF THE CIVIL REGISTRAR

This is to certify that the foundling herein named is reported to this Office for registration on ________________________________________ and properly recorded in the Register of Foundling.

_______________________________________(Signature over printed name of the Civil Registrar)

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