Certificate of Live Birth

Child's Name & Birth Info

Legal name and sex of the child

Required

First Name *

Please enter the child's first name.

Middle Name (optional)

Last Name *

Please enter the child's last name.

Sex *

Male Female

Please select the child's sex.

Child's Birth Date

Exact date of birth

Required

Day *

Month *

Year *

Place of Birth

Where the child was born

Hospital / Clinic / Institution / House No., St., Barangay

City / Municipality

Province

Birth Details

Type of birth, order, and weight

Type of Birth

If Multiple, Child Was

1st = first born, 2nd = second, etc.

Specify Other Type

Birth Order

Weight at Birth (kg)

Mother's Information

Maiden name, citizenship, and birth history

Required

First Name *

Middle Name (maiden)

Last Name *

Citizenship

Religion

Occupation

Age at Time of Birth

Total Born Alive

Still Living

Now Deceased

Mother's Residence

Current home address

House No., St., Barangay

City / Municipality

Province

Country

Father's Information

Full name, age, and occupation

Required

First Name *

Middle Name

Last Name *

Age at Birth *

Citizenship

Religion

Occupation *

Father's Residence

Current home address

House No., St., Barangay

City / Municipality

Province

Country

Marriage of Parents

Leave blank if the parents are not married

If parents are not married, they must accomplish the Affidavit of Acknowledgement / Admission of Paternity separately.

Month

Day

Year

City / Municipality

Province

Country

Attendant at Birth

Who delivered the child

Required

Select Attendant *

Specify Other Attendant

Certification of Attendant

Details of the attendant signing the certificate

Required

Full Name

Title / Position

Address

Date of Certification *

Time of Certification *

Certification of Informant

The person providing the information

Full Name

Relationship to the Child

Date

Address

Prepared By

LCRO staff who prepared this form

Full Name

Title / Position

Date