‘Muricipal Form No. 102 (Tobe accomplished in quadruplicate using black ink) ee ae Republic of the Philippines OFFICE OF THE CIVIL REGISTRAR GENERAL, CERTIFICATE OF LIVE BIRTH ‘METRO MANILA Registry No. pre cs ence DC) AN 9 ~ 1, i cial a AREY is och ge TARE {one Fah Tae) iat AVISHAI ISSACHAR ____CEBRANO PORRAL 2. SEX (Male / Female) 3. DATE OF (Pay) (Month) (Year) MALE BIRTH 6 FEBRUARY 2019 Thame of FogpiigGininattononT (Cryin Proving ‘RIACE OF tute No. Se: Borangay) ras eos ‘CHRIST THE KING MEDICAL CENTER UNIMEALTH LAS PINAS, 130 REAL STREET. PAMPLONA LAS PINAS CITY METRO MANILA ‘a, TYPE OF BIRTH ‘5. IF MULTIPLEBIRTH, CHILD WAS | 5c.BIRTHORDER curcrnsimo |. WEIGHTAT BIRTH (igo.Twin. Trot, te) (Fit, Second, Third, et) aie SINGLE N/A _FIRST. 950 grams 7. MAIDEN First) (middle) (Last) NAME: LENIE GERALDO. CEBRANO. ‘8 CTZENSHP 9, RELIGIONRELIGIOUS SECT FILIPINO CHRISTIAN 40a. Toa ruber of | 10b, No.of ehiden ti [106 No.of hldren bom | #1. OCCUPATION ‘enloren Bom ave | ving ncuding this ith | ive Bu ae now dead 1 1 0 | HOUSEWIFE 43. RESIDENCE (House No.. Si, Barangay) (CityiMnicipality) (Province) (Country) — 1304 FRUTO SANTOS AVENUE TRAMO ZAPOTE, LAS PINAS CITY, METRO MANILA, PHILIPPINES 14. NAME RUpOLH VALENTINE “OF ANDA PORRAL Ur—-r10 YR. AGE athe Ge ans ‘th colts yar) 20 pmIA0= 16 CITZENSHP 76 RELGIONRELIGIOUSSECT {7 OCCUPATION 18. AGE ate me da FILIPINO CHRISTIAN BUSINESSMAN eee 1. RESIDENCE (House No,, St, Barangay) (Cityiunicipalty) (Provines) (Country) 1304 FRUTO SANTOS AVENUE TRAMO ZAPOTE, LAS PINAS CITY, METRO MANILA, PHILIPPINES MARRIAGE OF PARENTS (itrot marie, accomplish Aide of AcnowiedgemertAdission of Paterity tthe back) j2oa. DATE (Month) (Day) (Year) ‘20b.PLACE —(City/ Municipality) (Province) (Country) SEPTEMBER 17, 2018 ___ BARUGO, LEYTE, PHILIPPINES pmia>T 21a. ATTENDANT X14 Physician 2. Nurse 3 Midwite 4 lot (Tradlional Bith Atendant) __5. Others (Specify) _ l2tb. CERTIFICATION OF ATTENDANT AT BIRTH 7s, Nurse, awe, Traction Birth AtlendanMiot ete) | hereby certly th | attended the bith of the child who was bom alive at 4.34 AM_amlom on the date of birth specified above. Signature _} enh ‘Address —_ CHRIST THE KING MEDICAL CENTER UNEALTHLAS PINAS. Name in Print LEONIDA C. TRINIDAD M.D. ___130 REAL ST.PAMPLONA LAS PINAS CITY. Title or Position PHYSICIAN __ Date __ 3RUARY 6, 2019 __ 22. CERTIFICATION OF INFORMANT 23, PREPAREDBY | hereby certify that al nformation supplied are true and ‘correct to my own knowledge/ang be caus neat cc ee Name in rent RUDOLSALENTINE H. PORRAL | Name in Print IR. Relationship tothe Child FATHER te or Postion _ MEDICAL RECORDS CLERK __ Address ___SAME AS ABOVE _____—> ay, _ FEBRUARY 6.2019 = Date FEBRUARY 6, 2019 - 24 RECEVEDEY 75 REGISTERED AT THE OFFICE OF THE GVL REGISTRAR Signature sigan eae eee eer Name in Pit REYES Name in Pont Tite or Postion ADMINISTRATIVE AIDE IT ___Tite or Position | ose 813g om FEB 13.2019 a Taarnna marentanmerrraTicaan dies (ire 1G Use Only)