Living beneficiary
Republic of the Philippines
                                       Province of
                                   Municipality of
                               Barangay
                                                        -o0o-
                               CERTIFICATION
                                                      2X2
                                                      Signature
THIS IS TO CERTIFY that                                               _______,            years old
                                                 (Name)                          (Age)
                           , whose picture and signature appears above, is a bonafide resident of this
    (Civil Status)
Barangay. That he/she is the                                               _____ and currently the custodian
                                         (Relation to senior citizen)
/caretaker of                                                   .
                      (Name of the senior citizen)
That he/she is being authorized by                                                       the social
                                                     (Name of the senior citizen)
Pension beneficiary, to claim the stipend from the social pension program for and his/her behalf.
         This certification is issued for whatever purpose it may serve.
Issued this       day of                                        , 2023.
                                                  Punong Barangay