CRG Form No.

101 (To be accomplished in triplicate)

(Revised January 1993)
Republic of the Philippines
CERTIFICATE OF FOUNDLING

Province ____________________________________________________ Registry No.

City / Municipality _____________________________________________

1. NAME 2. SEX

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

C 5. PLACE WHERE FOUND
H
6. COLOR OF THE EYES 7. COLOR OF THE HAIR.
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8. DISTINCT BODY FEATURES OR MARKS
D
9. CONDITION OF THE CHILD WHEN FOUND

10. Name _________________________________________________________________________

F
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N Address _______________________________________________________________________
D
E Telephone No. (if any) ______________________ Occupation ___________________________
R

I 11. Name _________________________________________________________________________

N
F
O
R
Address _______________________________________________________________________
M
A
N
Telephone No. (if any) _______________________ Occupation __________________________
T

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)
C
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13. CERTIFICATION OF THE CIVIL REGISTRAR
V
I
L 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.
R
E
G
I
S _______________________________________
T
R
(Signature over printed name of the Civil Registrar)
A
R