OCRG Form No. 101 (Revised August 2021) (To be accomplished in triplicate using black ink) Republic of the Philippines OFFICE OF THE CIVIL REGISTRAR GENERAL CERTIFICATE LIVE BIRTH Registry No. Province City/Municipality (First) 1. NAME (Male/Female) 2. SEX (Middle) 3. APPROXIMATE AGE WHEN FOUND (Last) 4. DATE WHEN FOUND (Day) (Month) 5. TIME WHEN FOUND 6. APROXIMATE DATE OF BIRTH (Year) (Day) C H 7. PLACE WHERE FOUND I L D 8. COLOR OF THE EYES (House No., St., Barangay) (City/Municipality) 9. COLOR OF THE HAIR 11. CONDITION OF CHILD WHEN FOUND Healthy 13. NAME F I 14. SEX (Male/Female) N D E R 18. RESIDENCE I 19. NAME N F O 20. SEX (Male/Female) R M A 24. RESIDENCE N T (Month) (Province) 10. DISTINCT BODY FEATURES OR MARKS 12. CITIZENSHIP OF THE CHILD with Health Issues (First) 15. AGE (Middle) (completed years) 16. PHONE / EMAIL (House No., St., Barangay) 17. OCCUPATION (City/Municipality) (First) 21. AGE (Last) (Province) (Middle) (completed years) (Last) 22. PHONE / EMAIL (House No., St., Barangay) 23. OCCUPATION (City/Municipality) (Province) 25. CERTIFICATION OF INFORMANT THIS IS TO CERTIFY that the information given above are true and correct to my own knowledge and belief. Signature Over Printed Name of the Informant SUBSCRIBED AND SWORN to before me this day of , at , Philippines, affiant who exhibited to me his/her Community Tax Certificate or any government issued ID issued on . at Signature of the Administering Officer 26. PREPARED BY Name in Print Signature Over Printed Name Position / Title / Designation Title or Position Address Date 27. RECEIVED BY 28. REGISTERED AT THE OFFICE OF THE CIVIL REGISTRAR Signature Over Printed Name Signature Over Printed Name Title or Position Title or Position Date Date REMARKS/ANNOTATIONS (For LCRO/OCRG Use Only) (Year)