Certificate RSBSA Felicia

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BARANGAY CERTIFICATE

This is to certify that _______________________________________________________________


(Surname) (First Name) (Middle Name)

Age ________ residing at ____________________________________________________________


(Complete Address-Purok, Barangay, City/Municipality, Province)

_____________________________is tilling the following crop(s):

Farm Commodity Size (ha.) Tenurial Status Since


Location (Rice/Corn/HVC) (Owner/Tenant/Lease/specify) (Month/Day/Year)

This certification is being issued by the barangay solely for the purpose of the farmers and fisher folk
registration to the Registry System for Basic Sectors in Agriculture (RSBSA) of the Department of Agriculture,
and may not be used for other purposes not mentioned above.

_______________________________________ ___________________
Name and Signature of Barangay Chairman Date

_______________________________________
Barangay

_______________________________________
City/Municipality

_______________________________________ _______________________________________
Name and Signature of Farmer/Fisher Name and Signature of Neutral
Third – Party Witness

________________ ________________
Date Date

_______________________________________
Name and Signature of Neutral
Third – Party Witness

________________
Date

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