Complete name of the child (first, middle, last)
Complete name of the father
Complete maiden name of the mother
Date of birth (month, day, year)
Place of birth (city/municipality, province)
Whether or not registered late. (If registered late, please state the year when it was registered.
Complete name and address of the requesting party
Relationship to the child
Number of copies needed
Purpose of the certification
NOTE: ISSUANCE OF CERTIFICATION OF BIRTH IS SUBJECT TO THE CONFIDENTIALITY CLAUSE OF ARTICLE 7 OF THE CHILD AND YOUTH WELFARE CODE WHICH PROVIDES:
Art. 7. Nondisclosure of birth records. The records of a person's birth shall be kept strictly confidential and no information relating thereto shall be issued except on the request of any of the following:
The person himself, or any person authorized by him;
His spouse, his parent or parents, his direct descendants, or the guardian or institution legally incharge of him, if he is a minor;
The court or proper public official whenever absolutely necessary in administrative, judicial or other official proceedings to determine the identity of the child's parents or other circumstances surrounding his birth; and
In case of the person's death, the nearest of kin.
Any person violating the prohibition shall suffer the penalty of imprisonment of at least two months or a fine in an amount not exceeding five hundred pesos, or both, in the discretion of the court.