VERIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that Mr./Miss/Mrs. _______________________________

has fully complied and submitted the following documents in proper order:

________ Certificates of Tribal Membership from the Barangay and Tribal

Chieftain Leaders and applicants place of origin
________ Xerox copy Birth Certificate
________ Joint Affidavit of two (2) disinterested persons to the tribal
membership of the applicant
________ Two (2) copies 2” X 2” picture (Cell phone copied pictures are not
accepted)
________ Documentary stamps (2pieces)
________ Endorsement from concerned CDO III and PROVINCIAL
OFFICER.

RECEIVING OFFICER:

__________________________
(Name and Signature)

__________________________
(Position)

This is to certify that we have examined the above documents and we are
fully satisfied of their authenticity. We likewise certify that we have interviewed
the applicant and declare to the best of our knowledge that the applicant belongs
to the ____________________________ tribe.

Evaluated and Verified by the COC Committee members:

___________________ ____________________ __________________

(Name and Signature) (Name and Signature) (Name and Signature)

___________________ ____________________ __________________

(Position) (Position) (Position)

REMARKS:

LAH/RO
 Republic of the Philippines
Office of the President
NATIONAL COMMISSION ON INDIGENOUS PEOPLES
REGIONAL OFFICE XII

COC Form I

CERTIFICATE OF CONFIRMATION

INFORMATION INDEX

Purpose: (Check only one (1) box)

( ) 1. Scholarship ( ) 5. Civil Service Requirement
( ) 2. Local Employment ( ) 6. NAPOLCOM
( ) 3. Land Matter ( ) 7. Others: Specify
( ) 4. Travel Abroad _____________________________

I. PERSONAL INDEX (Please print all entries legibly)

Name _________________________________ Civil Status ________________
Address _________________________________________________________
Place of Birth __________________________ Tribe ______________________
Date of Birth ______________ If married, name of spouse _________________
___________________________________ Tribe ________________________

II. EDUCATIONAL BACKGROUND:

Highest Educational Attainment: ______________________________________
Degree Obtained: _________________________________________________

III. PARENTAL BACKGROUND:

Father
Name _______________________
Address _____________________
Tribe _______________________
Grandfather __________________
Tribe _______________________
Grandmother _________________
Tribe _______________________
Mother
Name ________________________
Address ______________________
Tribe ________________________
Grandfather ___________________
Tribe ________________________
Grandmother __________________
Tribe ________________________

IV. If purpose of certification is land matter, fill up the following:

Homestead/Free Patent No. __________________ Lot No. ________________
Date of Issuance ___________________________ Area __________________
Location _________________________________________________________
I declare under the penalties of perjury that the answers given are true
and correct to the best of my knowledge and belief.

_____________________________
(Printed Name/Signature of Applicant)

Res. Cert. No. ________________________

Issued at ____________________________
Issued on ___________________________
Republic of the Philippines )
Province of ______________) S. S.
Municipality of ____________)

JOINT AFFIDAVIT OF TWO-DISINTERESTED PERSONS

WE, ___________________________ and _____________________________

Both of legal age, Filipino citizen, single/married and bonafide residents of
_______________________________ and ___________________________________
Philippines respectively. After been duly sworn in accordance with the law, do hereby
depose and say:

That we know personally ________________________________________ and

________________________________ to be husband and wife being our neighbors at
___________________________________________.

That after couple of years living together the couple have a child born name
_____________________________ as their _________________________ born child.

That __________________________ is a member of the tribal communities

belonging to the _____________________________ being his/her father
_____________________________ and mother _______________________ belonging
To the ______________________ and ______________________ tribes respectively.

That we executing this Joint Affidavit to establish the fact and truth surrounding
the tribal membership of _________________________________________________.

IN WITNESS WHEREOF, we have hereunto affixed our signature this ________

Day of ____________, _________ at ______________________________, Philippines.

_____________________________
Affiant
Comm. Tax Cert. No. ___________
Issued on:____________________
Issued at: ____________________
_____________________________
Affiant
Comm. Tax Cert. No ____________
Issued on: ____________________
Issued at: _____________________

SUBSCRIBED AND SWORN to before me this_______ day of ____________,

________ at ________________________________________, Philippines.

WITNESS MY HAND AND SEAL.

Doc. No. ___________

Page N. ___________
Book No. __________
Series of __________
 Republic of the Philippines
OFFICE OF THE PUNONG BARANGAY
Province of ______________
Municipality of ____________
Barangay of ______________
=============================================================

______________________
Date

CERTIFICATION

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that __________________________________ is a

resident of ________________________________________________.

This certification is issued upon his/her request to support his/her

application for the Certificate of Confirmation of Tribal Membership.

__________________________________
Punong Barangay
 Republic of the Philippines
OFFICE OF THE TRIBAL CHIEFTAIN
Province of ______________
Municipality of ____________
Barangay of ______________
=============================================================

______________________
Date

CERTIFICATION

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that __________________________________ of

_______________________________belonging to the _____________ tribe of
Indigenous Peoples. His/her parents ____________________________ and
_________________________ being members of the
_____________________________ and _____________________________
tribes, respectively.

__________________________________
Tribal Chieftain