MAYOR'S CLEARANCE APPLICATION

TO WHOM IT MAY CONCERN:

First Name *

Middle Name

Last Name *

Barangay/Resident of *

Gender *

Purpose (PMA) * This clearance is issued upon the request of the interested party for the specified purpose only.

Certification Statement:

This is to certify that [NAME], resident of [BARANGAY] is personally known to me. (He/she) is a person of good moral character and a law-abiding citizen.

According to the official records of this office, the said person has no derogatory record/information as of this date.

This clearance is issued upon the request of the interested party for [PURPOSE] purposes only.