Acknowledgement Form

Your request(s) for copies of Birth / Marriage / Death Certificates / CENOMAR (Singleness) have been
confirmed.

Please print TWO (2) copies of this page.

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You will be asked for a copy of this page upon paying for your requests in our designated banks.

A copy of this Acknowledgement Form has also been sent to you through email.

Requester's Name: JENNY LYN L. HABACON

Delivery Address: #677 BGY. LINGGA
CALAMBA CITY, LAGUNA
PHILIPPINES 4027
Request Date: 5/5/2009

Batch Request Number: 0341-2004-8900-0101

Total No. Of Copies Requested: 1

Total Amount Due: PHP 315.00

Request Request Type Request Details Copies Amount

Reference
Number Name Date Place (in PHP)

PHILIPPINES
JENNY LYN
0341-2004-8900- COPY ISSUANCE - BIRTH LAGUNA
LANTACON 9/30/1982 1 315.00
1116 CERTIFICATE CALAMBA
HABACON
CITY

Use the BATCH REQUEST NUMBER when you are paying for ALL the requests that you have submitted
online and when you are inquiring about the processing status of ALL your requests in a batch using the
Verify Request Status facility in the e-Census website.
Use the REQUEST REFERENCE NUMBER when you are paying for a SINGLE request and when you are
inquiring about the processing status of a SINGLE request using the Verify Request Status facility in the
e-Census website. Also use the Request Reference Number when inquiring about the location of your
requested document/s with our local courier.

You can pay at any Equitable PCI Bank, UnionBank or Mail and More outlet (except for the outlets located
in SM malls) nationwide. Equitable PCI Bank account holders may pay via FASTPhone, FASTeller ATM and
FASTNet online payment (please refer to the FAQs for additional information). You can also pay online
using your Megalink ATM card (via The PORT) or through our Online Credit Card Payment facility.