Model

Barangay
Citizen
Charter

1|Page
 Message
Mission and Vision
Performance Pledge

2|Page
 Table of Contents

Page
Menu of Key Services 1
Application for Barangay Business Permit 2
Application for Barangay Clearance
Application for the Use of Barangay Properties and
Facilities
Request for Barangay Certification 3
Request for Certified Records
Issuance of Community Tax Certificate 4
Registration of Transient 5
Screening of Patient for Health Services 7
Enrolment to Daycare Center 5
Filing of Complaint
Request for Certificate to File Action
Forms 6
Application for Barangay Clearance (Barangay
Form 1)
Request for Barangay Certification (Barangay
Form 2)
Order of Payment (Barangay Form 100)
Feedback Form (Barangay Form 200)
Directory 7

3|Page
Menu of Key of Services

Frontline Services Fees How long Where to go? Reference

will it Page
take?
1 Office of Barangay
Application for Secretary,
20
Barangay P_______ Barangay Hall,
minutes
Clearance Barangay____________,
Tanay, Rizal
2 Office of Barangay
Request for Secretary,
15
Barangay P_______ Barangay Hall,
minutes
Certification Barangay____________,
Tanay, Rizal
3 Office of Barangay
Avail Justice Lupong Tagapamayapa,
P_______
Service Barangay____________,
Tanay, Rizal
4 Barangay Health Center,
Avail Health 30 Barangay
Free
Service minutes ____________________,
Tanay, Rizal
5 Barangay Daycare
Registration for
30 Center, Barangay
Daycare Free
minutes __________________,
Service
Tanay, Rizal
6

4|Page
 Application for Barangay Business Permit
Who may avail?

Stores or retailers with fixed business establishments within the barangay whose gross
sales or receipts for the preceding does not exceed P30,000.00 (Section 152a of RA7160).

What are the requirements?

 Duly accomplished Application for Barangay Business Permit/Clearance

Form (Barangay Form 1);
 Original and photocopy of Business name registration;
 Basis for computing taxes, fees and charges, eg. Business capitalization,
income tax returns, etc)
 Occupancy Permit, if required;
 Contract of Lease;
 Community Tax Certificate;
 Original copies of 2 valid government-issued ID;
 Authorization Letter, if thru authorized representative
 Presentation of valid ID and submission of photocopy of valid ID of
representative; and
 Payment of taxes, fees and charges

When to file?

Mondays to Fridays, 8:00am to 5:00pm

How long will it take?

1 – 2 days

How to avail the service?

5|Page
 Application for Barangay Clearance
Who may avail?

Any business or activity located or conducted within the territorial jurisdiction of the
barangay before the city or municipality may issue a license or permit to said business or
activity (Section 152c of RA7160).

What are the requirements?

 Duly accomplished Application for Barangay Clearance Form (Barangay

Form 2)
 Community Tax Certificate;
 Original copies of 2 valid government-issued ID;
 Contract of Lease, if applicable;
 Authorization Letter, if thru authorized representative
 Presentation of valid ID and submission of photocopy of valid ID of
representative;
 Payment of clearance fees;
 Other requirements:

1 For construction-related permits

 Original and photocopy Real Property Tax Clearance (land,
improvement, machinery);
 Original and photocopy of Proof of ownership
(Original/Transfer Certificate of Title, Deed of Sale, etc);
 Original and photocopy of Tax Declaration;
 Original and photocopy of RPT payment clearance; and
 1 complete set of plan together with bills of materials

2 For City/Municipal Business Permit (New/Renewal)

 Basis for computing taxes, fees and charges, eg. Business

capitalization, income tax returns, etc)
 Occupancy Permit, if required;

3 For Zonal/Locational Permit

 Original and photocopy Real Property Tax Clearance (land,

improvement, machinery);
 Original and photocopy of Proof of ownership
(Original/Transfer Certificate of Title, Deed of Sale, etc);
 Original and photocopy of Tax Declaration;
 Original and photocopy of RPT payment clearance; and
 Vicinity/Sketch Map

4 For Tricycle Operators Permit

 Original and photocopy of OR and CR/Sales Invoice

 Proof of payment Barangay TODA membership dues

6|Page
 When to file?

Mondays to Fridays, 8:00am to 5:00pm

How long will it take?

1 – 2 days

How to avail the service?

Response Person in
Step Client Service Provider Forms
Time Charge
a. Approaches Frontline- a. Greets applicant 5 minutes Frontline - Barangay
Barangay Treasury Office BTO Form 2
(BTO)

b. Fills out and submits duly b. Gives Barangay Form 2

accomplished Application for to be filled out by applicant
Barangay Clearance Form
(Barangay Form 2) and
documentary requirements

c. Presents IDs, if c Reviews and validate

personally filed; and if filed submission
1 by a representative,  Assesses eligibility
applicant’s ID, for renewal based
representative ID and on record of
authorization letter business
 Fill-out assessments
of applicable fees at
the back of
Barangay Form 2
 Returns Barangay
Form 1 and directs
the applicant to the
collecting office to
pay required fees
a. Goes to the collecting a. Receives Barangay Form 5 minutes Cashier Barangay
officer to pay required fees 2 and payment Form 2 and
and pays the required fees OR
2
b. Receives Official Receipt b. Issues OR and directs the
(OR) applicant to return to the
Officer-of-the-day to submit
Barangay Form 2 and OR
a. Returns to the Frontline- a. Receives OR 10 minutes Frontline- Barangay
BTO to submit Barangay  Checks payment BTO/Punong Clearance
Form 2 and OR details Barangay
 Notes down OR
details at the bottom
3 part of Barangay
Form 2
 Encodes applicant
information in the
database

7|Page

b. Signs receipt portion of
Barangay Form 1 and
receives Barangay Business
Permit
c. Fills-out Feedback Form
(Barangay Form 200) and
drops accomplished
Barangay Form 200 to
Feedback Form drop box
Application for Barangay Clearance
Service Process Workflow
8|Page
 Verifies applicant’s
information in
Barangay Profiling
Information System
 Prepares Barangay
Business Permit
 Signs Barangay
Business Permit
b. Asks the applicant to
receive Barangay Business
Permit by signing at the
receipt portion of Barangay
Form 1 Barangay
Form 200
c. Asks the applicant to fill-
out Barangay Form 200 and
to drop the accomplished
form to feedback drop box
d. Tells client parting words,
“Have a nine day!”
9|Page
 Application for the Use of Barangay-Owned Properties
and Facilities
Who may avail?

Any person/s or group/organization who may use barangay-owned properties and

facilities

What are the requirements?

 Duly accomplished Application for Use of Barangay Properties and

Facilities Form (Barangay Form 5)
 Community Tax Certificate;
 Original copies of 2 valid government-issued ID;
 Authorization Letter, if thru authorized representative
 Presentation of valid ID and submission of photocopy of valid ID of
representative;
 Payment of fees;

When to file?

Mondays to Fridays, 8:00am to 5:00pm

How long will it take?

1 – 2 days

How to avail the service?

Response Person in
Step Client Service Provider Forms
Time Charge
a. Approaches Frontline- a. Greets applicant 5 minutes Frontline- Barangay
Barangay Treasury Office BTO Form 2
(BTO)
b. Gives Barangay Form 1 to
b. Fills out and submits duly be filled out by applicant
accomplished Application for
Barangay Business
Permit/Clearance (Barangay
Form 1) c Asks applicants to present
valid IDs and notes down the
c. Presents IDs, if personally ID presented at the
1 filed; and if filed by a corresponding field of
representative, applicant’s Barangay Form 1
ID, representative ID and
authorization letter  Examines the
accomplished
Barangay Form 1 if
all fields have been
filled out
 Prepares Order of Barangay
Payment (Barangay Form 100
Form 100)

10 | P a g e

d. Receives Barangay Form
100
a. Goes to the collecting
officer to pay required fees
b. Pays the required fees
2
c. Receives Official Receipt
(OR)
a. Returns to the Officer-of-
the-day to submit OR
3  Prepares Barangay
b. Signs receipt portion of
Barangay Form 1 and
receives Barangay
Certification
c. Fills-out Feedback Form
(Barangay Form 200) and
drops accomplished
Barangay Form 200 to
Feedback Form drop box
11 | P a g e
 Notes down request
details therein
d. Gives Barangay Form 100
and directs applicants to the
collecting office to pay
required fees
a. Gets Barangay Form 100, 5 minutes Cashier Barangay
checks if the amount tallies Form 100
with the purpose
b. Receives payment and
notes down Barangay Form
100 series and date as
remarks of OR
c. Issues OR and directs the
applicant to return to the
Officer-of-the-day to submit
Barangay Form 100 and OR
a. Receives OR 10 minutes Officer-of- Barangay
 Checks payment the-day Clearance
details
 Notes down OR
details at the bottom
part of Barangay
Form 1
 Encodes applicant
information in the
database
 Verifies applicant’s
information in
Barangay Profiling
Information System
Clearance
b. Asks the applicant to
receive Barangay Clearance
by signing at the receipt
portion of Barangay Form 1
c. Asks the applicant to fill-
out Barangay Form 200 and
to drop the accomplished Barangay
form to feedback drop box Form 200
d. Tells client parting words,
“Have a nine day!”
 Request for Barangay Certification
Who may avail?

Barangay resident of more than 6 months may apply personally or through

authorized representative.

What are the requirements?

 Duly accomplished Request for Barangay Certification Form (Barangay

Form 2);
 Community Tax Certificate, if applicable;
 Authorization Letter, if thru authorized representative
 Presentation of valid ID and submission of photocopy of valid ID of
representative
 Payment of certification fees

When to file?

Mondays to Fridays, 8:00am to 5:00pm

How long will it take?

30 minutes

How to avail the service?

Ste Client Service Provider Respon Fees Forms

p se Time Perso
n in
Charg
e
1 a. Approaches a. Greets 5 Officer Barangay
Officer-of-the-day applicant minutes -of- Form 2
the-
b. Fills out and b. Gives day
submits duly Barangay Form 2
accomplished to be filled out by
Request for applicant
Barangay
Certification/Cleara
nce (Barangay
Form 2)

c. Presents IDs, if c Asks applicants

personally filed; to present valid
and if filed by a IDs and notes
representative, down the ID
applicant’s ID, presented at the
representative ID corresponding

12 | P a g e
 and authorization field of Barangay
letter Form 2
Barangay
 Examines Form 100
the
accomplis
hed
Barangay
Form 2 if Barangay
all fields Forms 2
have been and 100
filled out
 Prepares
Order of
Payment
d. Receives (Barangay
Barangay Form Form 100)
100  Notes
down
request
details
therein

d. Gives
Barangay Form
100 and directs
applicants to the
collecting office to
pay required fees
2 a. Goes to the a. Gets 5 Cashi *Ref Barangay
collecting officer to Barangay Form minutes er er to Form 100
pay required fees 100, checks if the the
amount tallies list of
b. Pays the with the purpose fees
required fees on
b. Receives page
payment and __
notes down
Barangay Form
100 series and
c. Receives Official date as remarks
Receipt (OR) of OR

c. Issues OR and
directs the
applicant to return
to the Officer-of-
the-day to submit
Barangay Form
100 and OR

13 | P a g e
 3 a. Returns to the a. Receives OR 10 Officer Barangay
Officer-of-the-day  Checks minutes -of- Certificati
to submit OR payment the- on
details day
 Notes
down OR
details at
the bottom
part of
Barangay
Form 2
 Encodes
applicant’s
informatio
n in the
database
 Verifies
applicant’s
informatio
n in
Barangay-
IT System
b. Signs receipt  Prepares
portion of Barangay Barangay
Form 2 and Certificatio
receives Barangay n
Certification
b. Asks the
applicant to
receive Barangay
c. Fills-out Certification by Barangay
Feedback Form signing at the Form 200
(Barangay Form receipt portion of
200) and drops Barangay Form 2
accomplished
Barangay Form c. Asks the
200 to Feedback applicant to fill-
Form drop box out Barangay
Form 200 and to
drop the
accomplished
form to feedback
drop box

14 | P a g e
 Issuance of Community Tax Certificate
(with deputation from Local Treasurer)

Who may avail?

The following shall obtain Community Tax Certificate:

1 Barangay resident who is 18 years old and stays in the barangay for more than
6 months; and

2 Any person who established, operated or conducted any business, trade or

commercial activity within the barangay.

What are the requirements?

 Duly accomplished Request for Barangay Certification Form (Barangay

Form 2);
 Authorization Letter, if thru authorized representative
 Presentation of valid ID and submission of photocopy of valid ID of
representative; and
 Payment of community tax

When to file?

Mondays to Fridays, 8:00am to 5:00pm

How long will it take?

30 minutes

How to avail the service?

Step Client Service Response Person Fees Forms

Provider Time in Charge
1 a. Approaches a. Greets 5 minutes Officer-of- Barangay
Officer-of-the- applicant the-day Form 2
day
b. Gives
b. Fills out and Barangay
submits duly Form 2 to be
accomplished filled out by
Request for applicant
Barangay
Certification
(Barangay Form
2)

c. Presents IDs, c Asks

if personally applicants to
filed; and if filed present valid

15 | P a g e
 by a IDs and notes
representative, down the ID
applicant’s ID, presented at
representative the
ID and corresponding
authorization field of Barangay
letter Barangay Form 100
Form 2 and
d. Receives examines the
accomplished accomplished
Barangay Form Barangay
2 Form 2 if all
fields have
been filled out

d. Gives back
accomplished
Barangay
Form 2 and
directs
applicants to
the collecting
office to pay
required fees
2 a. Goes to the a. Gets 5 minutes Cashier *Refer Barangay
collecting officer Barangay to the Form 100
to pay required Form 2 and list of
fees encodes fees on
applicant’s page
information __
b. Pays the
required fees b. Receives
payment
c. Receives
Community Tax c. Issues
Certicate (CTC) Community
Tax
Certificate
3 Fills-out Asks the 10 Collecting Barangay
Feedback Form applicant to minutes Officer Form 200
(Barangay Form fill-out
200) and drops Barangay
accomplished Form 200 and
Barangay Form to drop the
200 to Feedback accomplished
Form drop box form to
feedback drop
box

16 | P a g e
 Request for Certified Records

Who may avail?

Any person who may request the following:

a Certified Records which is covered by Freedom of Information;

b Certificate to File Action from the Lupon Secretary; and
b Use of Facilities

What are the requirements?

 Duly accomplished Request for Certified Records/Use of Facilities Form

(Barangay Form 4);
 Authorization Letter, if thru authorized representative
 Presentation of valid ID and submission of photocopy of valid ID of
representative
 Payment of fees

When to file?
Mondays to Fridays, 8:00am to 5:00pm

How long will it take?

30 minutes

How to avail the service?

Step Client Service Provider Response Person Fees Forms

Time in
Charge
1 a. a. Greets applicant 5 minutes Officer- Barangay
Approaches of-the- Form 4
Officer-of-the- day
day

b. Fills out b. Gives Barangay

and submits Form 4 to be filled out
duly by applicant
accomplished
Request for
Certified
Records/Use
of Facilities
Form
(Barangay
Form 4)

c. Presents c Asks applicants to

IDs, if present valid IDs and

17 | P a g e
 personally notes down the ID
filed; and if presented at the
filed by a corresponding field of
representative, Barangay Form 4
applicant’s ID,
representative  Examines the
ID and accomplished
authorization Barangay
letter Form 4 if all
fields have
been filled out
 Prepares
Order of
Payment Barangay
(Barangay Form 100
Form 100)
 Notes down
request details
therein

d. Gives Barangay
Form 100 and directs
d. Receives applicants to the
Barangay collecting office to pay Barangay
Form 100 required fees Forms 4 and
100
2 a. Goes to the a. Gets Barangay 5 minutes Cashier *Refer Barangay
collecting Form 100, checks if to the Form 100
officer to pay the amount tallies with list of
required fees the purpose fees
on
b. Pays the b. Receives payment page
required fees and notes down __
Barangay Form 100
series and date as
remarks of OR

c. Issues OR and
c. Receives directs the applicant to
Official return to the Officer-
Receipt (OR) of-the-day to submit
Barangay Form 100
and OR

3 a. Returns to a. Receives OR 10 Officer- Certified

the Officer-of-  Checks minutes of-the- Records/Permit
the-day to payment day to Use
submit OR details
 Notes down
OR details at
the bottom part

18 | P a g e
 of Barangay
Form 4
 Encodes
applicant’s
information in
the database, if
applicable
 Verifies
applicant’s
information in
Barangay-IT
System
 Prepares
Certified
Records/Permit
to Use
b. Signs
receipt portion b. Asks the applicant
of Barangay to receive Certified
Form 4 and Records by signing at
receives the receipt portion of
Barangay Barangay Form 4
Certification

c. Fills-out c. Asks the applicant

Feedback to fill-out Barangay Barangay
Form Form 200 and to drop Form 200
(Barangay the accomplished
Form 200) and form to feedback drop
drops box
accomplished
Barangay
Form 200 to
Feedback
Form drop box

19 | P a g e
 Registration of Transient

Who may avail?

All transients who stays/resides/engages in any household, dormitories, boarding

houses, apartments, bed spaces and rooms including warehouses, hotels, inns,
apartelles, motels, pension houses for a period of more than three (3) days.

What are the requirements?

 Duly accomplished Transient Registration Form (Barangay Form 3)

 Presentation of Community Tax Certificate (CTC); and
 Original and photocopy of valid government-issued ID card

When to file?

Mondays to Fridays, 8:00am to 5:00pm

How long will it take?

15 minutes

How to avail the service?

Person
Response
Step Client Service Provider in Fees Forms
Time
Charge
1 a. Approaches a. Greets applicant 5 minutes Officer- Barangay
Officer-of-the-day of-the- Form 3
day
b. Fills out and b. Gives Barangay
submits duly Form 3 to be filled
accomplished out by applicant
Transient
Registration Record
(Barangay Form 3)

c. Presents IDs and c Asks applicants to

CTCs present valid IDs
 proceeds for and notes down the
image ID presented at the
capturing and corresponding field
fingerprint of Barangay Form 3
biometric
 Examines the
accomplished
Barangay
Form 3 if all
fields have

20 | P a g e
 been filled
out
 Encodes
applicant’s
information in
the database
and for image
capturing and
fingerprint
biometric
2 Fills-out Feedback Asks the applicant to 10 Officer- Barangay
Form (Barangay fill-out Barangay minutes of-the- Form 200
Form 200) and Form 200 and to day
drops accomplished drop the
Barangay Form 200 accomplished form
to Feedback Form to feedback drop
drop box box

21 | P a g e
 Screening of Patient for Health Care Service

Who may avail?

Any person may avail health care service of the barangay.

What are the requirements?

 Duly accomplished Patient Information Sheet (Barangay Form 5)

When to file?

Mondays to Fridays, 8:00am to 5:00pm

How long will it take?

30 minutes

How to avail the service?

Step Client Service Provider Response Person Fees Forms

Time in
Charge
1 a. Approaches a. Greets 5 minutes Barangay Barangay
Officer-of-the- applicant Health Form 5
day Worker

b. Fills out and

submits duly
accomplished b. Gives
Patient Barangay Form 5
Information to be filled out by
Sheet applicant
(Barangay Form
5)

c. Gives
accomplished
Barangay Form
5
c Examines the
accomplished
Barangay Form 5
if all fields have
been filled out

 Interview
and gets
d. Receives the patient
queuing number vital

22 | P a g e
 and takes a d. Asks the
seat patient to take a
seat until his/her
queue number or
name is called

 Encodes
patient
information
in the
database
2 Cooperates in a. Assesses the 15 Midwife Barangay
consultation patient; minutes or Nurse Form 100

b. Prescribes
medication
and/or laboratory
examination

c. Encodes
prescription to
Barangay IT
System
3 a. Returns to Gives instruction 10 BHW
the BHW-of-the- on medication, minutes
day and listens laboratory tests,
to the and follow-up
instruction

23 | P a g e
 Enrolment to Daycare Center

Who may avail?

Parents or guardian of child ages 4 years and below shall enroll their child/ren to
Barangay Daycare Center.

What are the requirements?

 Duly accomplished Sociodemographic Profile Sheet (Barangay Form 6);

 Photocopy of Child’s Birth Certificate; and
 Authorization Letter from parent, if thru authorized representative/guardian
 Presentation of government-issued ID of parent and submission of
photocopy of valid ID of representative

When to file?

Mondays to Fridays, 8:00am to 5:00pm

How long will it take?

30 minutes

How to avail the service?

Step Client Service Provider Response Person Fees Forms

Time in
Charge
1 a. a. Greets applicant 5 minutes Daycare Barangay
Approaches Worker Form 6
Daycare
Worker

b. Fills out b. Gives Barangay

and submits Form 6 to be filled out
duly by applicant
accomplished
Socio-
demographic
Profile Sheet
(Barangay
Form 6)

c. Presents c Asks applicants to

IDs, if present valid IDs and
personally notes down the ID
filed; and if presented at the
filed by a corresponding field of
representative, Barangay Form 6
applicant’s ID,

24 | P a g e
 representative  Examines the
ID and accomplished
authorization Barangay
letter and Form 6 if all
submits other fields have
requirements been filled out
 Asks for and
attaches
requirements
to Barangay
Form 6
d. Gets d. Gives schedule of
schedule of class opening and list
class opening of things to bring
and list of
things to bring e. Encodes daycare
child information to
BIT

25 | P a g e
 Filing of Complaint

Who may avail?

All disputes, civil and criminal in nature where parties actually reside in the same
city or municipality are subjected to proceedings of amicable settlement.

What are the requirements?

 Duly accomplished Request for Assistance Form (Barangay Form 7);

 Presentation of valid ID; and
 Payment of filing fees

When to file?
Mondays to Fridays, 8:00am to 5:00pm

How long will it take?

30 minutes

How to avail the service?

Step Client Service Provider Response Person Fees Forms

Time in
Charge
1 a. a. Greets 5 minutes Lupon Barangay
Approaches applicant and Secretary Form 7
Lupon gives Barangay
Secretary and Form 7 to be filled
fills out and out by applicant
submits duly
accomplished
Request for
Assistance
Form
(Barangay
Form 7)

b. Presents b. Examines the Barangay

IDs and accomplished Form 100
submits other Barangay Form 7
requirements if all fields have
been filled out
 Prepares
Order of
Payment
(Barangay
Form 100)
 Notes
down

26 | P a g e
 request
details
therein
 Gives
Barangay
Form 100
and directs
applicants
to the
collecting
office to
pay
required
fees
2 a. Goes to a. Gets Barangay 5 minutes Cashier *Refer Barangay
the collecting Form 100, checks to the Form 100
officer to pay if the amount list of
required fees tallies with the fees
purpose on
b. Pays the page
required fees b. Receives __
payment and
notes down
Barangay Form
100 series and
date as remarks
of OR

c. Receives c. Issues OR and

Official directs the
Receipt (OR) applicant to return
to the Lupon
Secretary to
submit Barangay
Form 100 and OR

3 a. Returns to a. Receives OR 10 Lupon KP Form

the Lupon  Checks minutes Secretary 7
Secretary to payment Barangay
submit OR details Form 200
and signs  Notes
Complainant’s down OR
Form (KP details at
Form 7) the bottom
part of
Barangay
Form 7
 Encodes
applicant’s
information
in the
database

27 | P a g e
  Verifies
applicant’s
information
in
Barangay-
IT System
 Prepares
and asks
client to
sign KP
Form 7
 Returns
receiving
copy of the
complaints
and
advises to
client to
wait for the
of Notice
of Hearing
to be
issued
within
three (3)
days
 Reminds
client to
accomplish
and drop
Feedback
Form
(Barangay
Form 200)
in the
designated
box and
tells clients
parting
words,
“Have a
nice day!”

28 | P a g e
 Request for Certificate to File Action

Who may avail?

Complainant/s may file action in court or any government office after having a
personal confrontation before the Punong Barangay/Pangkat ng Tagapagsundo and the
settlement has been repudiated.

What are the requirements?

 Duly accomplished Request for Certified Records/Use of Facilities Form

(Barangay Form 4);
 Authorization Letter, if thru authorized representative
 Presentation of valid ID and submission of photocopy of valid ID of
representative
 Payment of fees

When to file?
Mondays to Fridays, 8:00am to 5:00pm

How long will it take?

30 minutes

How to avail the service?

Step Client Service Provider Response Person Fees Forms

Time in
Charge
1 a. Approaches a. Greets 5 minutes Lupon Barangay
Lupon applicant and Secretary Form 4
Secretary, fills gives Barangay
out and Form 4 to be filled
submits duly out by applicant
accomplished
Request for
Certified
Record/Use of
Facilities Form
(Barangay
Form 4)

b. Presents
IDs, if b. Examines the Barangay
personally accomplished Form 100
filed; and if Barangay Form 4
filed by a if all fields have
representative, been filled out
applicant’s ID,  Prepares
representative Order of

29 | P a g e
 ID and Payment
authorization (Barangay
letter and Form 100)
submits other  Notes
requirements down
request
details
therein
 Gives
Barangay
Form 100
and directs
applicants
to the
collecting
office to
pay
required
fees
2 a. Goes to the a. Gets Barangay 5 minutes Cashier Barangay
collecting Form 100, checks Form 100
officer to pay if the amount
required fees tallies with the
purpose

b. Pays the b. Receives

required fees payment and
notes down
Barangay Form
100 series and
date as remarks
of OR
c. Receives
Official Receipt c. Issues OR and
(OR) directs the
applicant to return
to the Lupon
Secretary to
submit Barangay
Form 100 and OR

3 a. Returns to a. Receives OR 10 Officer- Barangay

the Lupon  Checks minutes of-the- Form 200
Secretary to payment day
submit OR details
 Notes
down OR
details at
the bottom
part of
Barangay
Form 4

30 | P a g e
  Encodes
applicant’s
information
in the
database
 Verifies
applicant’s
information
in
Barangay-
IT System
 Returns
receiving
copy of the
complaints
and
advises to
client to
wait for the
of Notice
of Hearing
to be
issued
within
three (3)
days
 Reminds
client to
accomplish
and drop
Feedback
Form
(Barangay
Form 200)
in the
designated
box and
tells clients
parting
words,
“Have a
nice day!”

31 | P a g e
 Request for Barangay Certification
(Guide and Checklist of Requirements)

A List of Requirements:

1 Original and properly accomplished Barangay Certification Form (Barangay Form 2);
2 Original copies of 2 valid government-issued ID card;
3 Certification fee: P______ per copy and Documentary Stamp: P_____ ; and
4 If through representative, please refer to additional requirements below.

B Choices for Government-issued ID Card/s:

1 Office ID
2 Taxpayer’s ID
3 Passport
4 SSS/GSIS or UMID
5 Driver’s License
6 PRC License
7 NBI Clearance
8 Police Clearance
9 Postal ID
10 Voter’s ID
11 Senior Citizen’s ID

C Additional requirements, if Request for Barangay Certification is filed through representative:

1 Authorization letter with hand-printed name and signature of authorized representative; and
2 Original copy of one (1) valid ID Card of the representative.

The accomplished forms (Barangay Form 2) may be submitted or sent through mail, together with the other
requirements to The Punong Barangay, Barangay _______________, Tanay, Rizal.

Payment of fee upon release.

32 | P a g e
 Barangay Form 5 (May 14 2019)
Republic of the Philippines
Province of Rizal Date:
Municipality of Tanay
BARANGAY ________________________
Number:
Patient Information Sheet
Lastname

Firstname

Middlename

Contact Number Email Address:

Unit# Phase Block# Lot# House# Street Name

Address

Subdivision Building/Apartment

Date of Birth Place of Birth

(mm/dd/yyyy) (City/Municipality/Province)
Male Single Married
Sex Civil Status
Female Widowed Separated/Divorced
Citizenship Occupation
Educational Relationship to
Attainment Household Head
Date of
Mother
Birth
Date of
Father
Birth
# of
Total Number of # of Male
Female Order of
Children/Sibling/s Child/ren/
Child/ren/ birth
born Sibling/s
Sibling/s
To be filled-out by Barangay Health Worker

Vital Signs:
Weight (kg): Height (cm):
Blood Pressure: Body Temperature:

33 | P a g e
 Barangay Form 6 (May 14 2019) Number:

Republic of the Philippines

Province of Rizal
Municipality of Tanay
BARANGAY ________________________

Sociodemographic Profile Sheet

Child’s Personal Information (Please print)
Lastname

Firstname

Middlename

Contact Number Email Address:

Address
Phas
Unit# Block# Lot# House# Street Name
e

Subdivision Building/Apartment
MM DD YYYY
Date of Birth Place of Birth
(City/Municipality/Province)
Sex  Male  Female Disability  Yes  No
Handedness?  Right  Left  Both  Not yet established
Presently  Yes If yes, write name of school/
studying?  No learning center/ daycare:

Number of
Birth Order (1st, 2nd, 3rd, etc)
Siblings?

Parent’s Personal Information (Please print)

Father Mother

Lastname

Firstname

Middlename
MM DD YYYY MM DD YYYY
Date of Birth

Place of Birth
(City/Municipality/Province) (City/Municipality/Province)
Occupation
Educational
Attainment
Brother/s and Sister/s Information

Name Sex Date of Birth Age

(MM/DD/YYYY)

34 | P a g e
 (Use additional sheet)

Brother/s and Sister/s Information (additional sheet)

Name Sex Date of Birth Age

(MM/DD/YYYY)

I hereby certify that the information is true and correct to the best of my knowledge.

___________________________________________
Name/Signature of person accomplishing this form
___________________
Date Accomplished
Attestation:
ID presented
Type
__________________________________________ Issued on
Daycare Worker Until

35 | P a g e
 Barangay Form 7 (May 14 2019) Number:
Republic of the Philippines
Province of Rizal
Municipality of Tanay
BARANGAY ________________________

Request for Assistance

Personal Information (Please print)
Lastname

Firstname

Middlename

Contact Number Email Address:

Address
Unit# Phase Block# Lot# House# Street Name

Subdivision Building/Apartment

Date of Birth Place of Birth

(mm/dd/yyyy) (City/Municipality/Province)
 Male  Single  Married
Sex Civil Status
 Female  Widowed  Separated/Divorced
Citizenship Occupation
Educational
Disability  Yes  No Attainment
Nature of request:

Nature/Details

I hereby certify that the information is true and correct to the best of my knowledge.

___________________________________________
Name/Signature of person accomplishing this form
__________________
Date Accomplished
Attestation:
ID presented
Type
__________________________________________ Issued on
Barangay Secretary Until
Payment Details

36 | P a g e
 OR# Amount Date

(Please see guide and checklist of requirements at the back page)

37 | P a g e
 Barangay Form 100 (May 14 2019)
Republic of the Philippines
Municipality of Tanay OP Number
BARANGAY _________________
Date
ORDER OF PAYMENT

THE COLLECTING OFFICER

Barangay Treasury Office

Please issue Official Receipt in favor of ________________________________________,

(payor)

____________________________________________________________________________
(address/office of payor)

in the amount of _______________________________________________________________

(P______________) for the payment of ____________________________________________.

(purpose)

Capital Investment
(For New Business): ________________
Gross Receipt
(For Business Renewal): _____________
Barangay Form No: _________________
Form series : _________________
Form date : _________________

Prepared by:

_______________________________
(Signature over printed name)

Designation: ____________________

38 | P a g e
 Barangay Form 200 (May 14 2019)
Republic of the Philippines
Municipality of Tanay FF Number
BARANGAY _______________

Feedback Form Date

We value your feedback. Please let us know how we have served you by completing this
form.

Name of Visitor:

Contact No:

Designation:
Office Name and
Address:
Sex  Male  Female

 17 and below  41 to 50
Age Group  18 to 30  51 to 60
 31 to 40  61 and over
Purpose of
Request
How would rate our service? Please put a check (/) mark.
(Paano po ninyo bibigyan ng marka ang aming ibinigay na serbisyo?)
Very
Poor
Excellent satisfactory Satisfactory Unsatisfactory
(Lubhang
Category (Napaka- (Lubos na (Kasiya- (Di kasiya-
di kasiya-
husay) kasiya- siya) siya)
siya)
siya)
Prompt
    
(Maagap)

Courtesy
    
(Magalang)

Adequate
    
(Sapat)
OVERALL
SERVICE     
DELIVERY
Recommendation(s)/Suggestion(s)/ Desired action from our office
(Rekomendasyon/Mungkahi/Nais na aksyon mula sa aming tanggapan):

___________________________________________________________________

39 | P a g e
40 | P a g e
Barangay Form 2

Eligibility/Exam Records Request Form (ERRF) Republic of the Philippines Date Accomplished by Client:
(Revised 01192011) CIVIL SERVICE COMMISSION
OFFICE NAME Time Accomplished by Client:
CIVIL SERVICE COMMISSION
OFFICE NAME Time Received by ESD/ERS P erso nnel:
REQUEST FOR ELIGIBILITY/EXAMINATION RECORDS Initials o f ESD/ERS P erso nnel:
Certification of Eligibility Authentication of Eligibility Others
(no/lost original certificate; attach Declaration) (attach original certificate)
PERSONAL INFORMATION (Please print. ) Gender:
Name Used at the Time Civil Status:
of Issuance/Exam: Last Name First Name Middle Name Presently employed? Yes No
Current Name: If yes, please specify:
Address Used at the Time of Issuance/Exam: Company:
Current Address: Address:
Date of Birth: Place of Birth:
Purpose/s of Request: Employment Replacement of Lost Certificate Did Not Receive Original Certificate
Promotion Replacement of Old/Torn/Worn-out Certificate Others
ELIGIBILITY/EXAMINATION DATA (Please print.)
Title of Eligibility/Exam: Rating Obtained: Date of Effectivity:
Date of Issuance/Exam: Registration/Certificate/Card/Resolution No.:
Place of Issuance/Exam: Registration/Certificate/Card/Resolution Date:
Requested By:

Signature of the Eligible/Examinee Right Thumb Print Authorized Representative

Signature at the Time of Issuance/Exam (Printed Name & Signature)
Contact No. (Examinee/Eligible) Contact No.
ACTION TAKEN
CHECKED DATA AGAINST THE ML CHECKED DATA AGAINST THE PSP
Book No. Page No. Seq./Line No. In Order Not In Order
School Code/Batch No. Examinee/Reg. No. Photo/Picture
Date Issued/Released: Signature
NO AVAILABLE RECORD Date of Birth
REMARKS REMARKS
Name/Signature/Initials: Security Form No.:
1st Verifier: 2nd Verifier: 1st Validator: 2nd Validator:
Date: Date: Date: Date:
RELEASE OF REQUEST/S Released by Received by
Fee: O.R. No.: Date:
Date: Action Officer Signature of Eligible/Representative Time:
(Please see Guide and Checklist of Requirements at the back page.)

About the service:

Barangay Certification is issued upon the request of the client for verifying
residency, good standing in the community, no pending case filed in the barangay and
for such other purposes.

41 | P a g e
Agricultural Support Services: Planting materials distribution system, Operations of
farm produce collection and buying stations

Health Services: Maintenance of barangay health center

Maintenance of barangay roads and bridges; and maintenance of water supply systems

Multi-purpose hall, multipurpose pavement, plaza, sports center and other similar
facilities;
Information and reading center; and satellite or public market, where viable

Social welfare services: maintenance of daycare center

Services related to general hygiene and sanitation; and solid waste collection; and
maintenance of katarungang pambarangay

A brief statement regarding the services concerned.

• Public Interface of the service concerned to be addressed (e.g.,
Reservation, Passenger amenities by Railways, Mail Delivery, Premium
services by Post etc.)
• Commitment to Standards (Time frame, Quality of service)
• Our Staff : What to except from them?
Where are they located?
• Keeping you informed : What information do you need?
• If things go wrong : What could go wrong;
Whom to contact;
What to expect to set it right.
• How you can help us?

42 | P a g e