Certificate of Live Birth (COLB)
Certificate of Live Birth (COLB)
Certificate of Live Birth (COLB)
TO BE FILLED UP AT THE
C 4. PLACE OF (Name of Hospital/Clinic/Institution/ (City/Municipality) (Province) OFFICE OF THE CIVIL
H BIRTH House No., Street, Barangay) REGISTRAR
I
41
L
D 5a. TYPE OF BIRTH b. IF MULTIPLE BIRTH, CHILD WAS
_____ 1 Single ______ 2 Twin _____ 1 First ______ 2 Second
______ 3 Triplet. Etc. ______ 3 Others, Specify _____________
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7. CITIZENSHIP 8. RELIGION
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M
O
T 9a. Total number of b. No. of Children still c. No. of children
children born living including born alive but
H alive: _________ this birth: _________ are now dead: _________
E 61
R 10. OCCUPATION 11. Age at the time
of this birth:
_______years
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12. RESIDENCE (House No., Street, Barangay) (City/Municipality) (Province)
_______________________________________________________________________________________________
19a. ATTENDANT
_____1 Physician ______ 2 Nurse ______ 3 Midwife 81
_____4 Hilot (traditional Midwife) ______ 5 Others (Specify)
_______________________________________________________________________________________________
19b. CERTIFICATION OF BIRTH
I hereby certify that I attended the birth of the child who was born alive at ______________o’clock
am/pm on the date stated above.
86 87
Signature ______________________________ Address ______________________________
20. INFORMANT
_________________________________ _______________________________
(Signature of Father) (Signature of Mother)
_________________________________________ _______________________________________
(Signature of Administering Officer) (Title/Designation)
_______________________________________________ ___________________________________________
(Name in Print) (Address)
1. That I am the applicant for the delayed registration of my birth/of the birth of
_______________________________________________________.
2. That I/he/she was born on ____________________ at _____________________________________________.
3. That I/he/she was attended at birth by _______________________________________________who resides at
_____________________________________________________________________________.
4. That I/he/she is citizen of _________________________________________________________.
5. That my/his/her parents were married on ____________________ at _______________________
_______________________________________________.
not married but was acknowledge by my/his/her father whose
name is ________________________________________________.
6. That the reason for the delay in registering my/his/her birth was due to ________________________________
________________________________________________________________.
7. That a copy of my/his/her birth certificate is needed for the purpose of ________________________________
________________________________________________________________.
8. (For the applicant only) That I am married to ________________________________________________.
_________________________________________
(Signature of Affiant)
________________________________________ _____________________________________
(Signature of Administering Officer) (Title/Designation)
_________________________________________________ ______________________________________________
(Name in Print) (Address)