11 PREPARED BY Riere 111 22. RECENAPOVENCE OF Sure BRN Documor av CARMELITAN ERICTA 141 1 CHILD'S PARTICULAPS 王丽珍 MOTHER'S 'NFORMANT S FATHES FEMALE Place or Address of Berth Name NRIC/Identification Document No F/PPT FF778233 Nationality Address Mane FILIPINO Nu identification Document No S/PINK S1176105D Natona ty Neme ONG LI ZHEN, SHENISSE Date of Birth Time of Birth 10/08/2001 MOUNT ELIZABETH HOSPITAL, SINGAPORE 1416 Hours Date of Birth CUARESMA REMY FERNANDEZ 10/11/1971 Race Dialect Group FILIPINO FILIPINO Country of Birth PHILIPPINES BLK 575 ANG MO KIO AVENUE 10 #08-1867 ONG HOCK HUAT SINGAPORE CITIZEN ONG HOCK HUAT Race CHINESE Dialect Group HOKKIEN Country of Birth SINGAPORE NRIC/Identification Document No Address FOR OFFICIAL USE Relationship FATHER AIPT BLK 575 ANG MO KIO AVENUE 10 #08-1867 THE CHILD IS A CITIZEN OF SINGAPORE AT THE TIME OF BIRTH Informant's Signature or Thumb impression 11/08/2001 NURASHIKIN BT A BAKAR 11/08/2001 Date ROSALES WESLEYAN ACADEMY, INC. San Pedro West, Rosales, Pangasinan CERTIFICATION Amex "E" TO WHOM IT MAY CONCERN: This is to certify that LIZHEN SHENISSE C. ONG of Esmeralda, Balungao. Pangasinan is a bonafide pupil of Rosales Wesleyan Academy, Inc.(formerly Wesleyan I earning Center) Rosales. Pangasinan this present School Year 2011-2012. This certification is issued for whatever legal purpose this may serve best. Issued this 16" day of January, 2012 at the office of the undersigned in Rosales Wesleyan Academy, Inc.. Resales. Pangasinan. MS. DEMIE B. BARBO |