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)