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11 PREPARED BY

Riere 111

22. RECENAPOVENCE OF
THE CIVIL RECUustrian

Sure

BRN
471-2

Documor av
Siamp Tax Fise

CARMELITAN ERICTA
Actitistrator and Registe
Natonal Stalsta Office

141 1

CHILD'S PARTICULAPS

[blocks in formation]

王丽珍

MOTHER'S
PARTICULARS

'NFORMANT S
PARTICULARS

FATHES
PARTICULARS

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
SINGAPORE 560575

ONG HOCK HUAT

SINGAPORE CITIZEN

ONG HOCK HUAT

Race

CHINESE

Dialect Group

HOKKIEN

Country of Birth

SINGAPORE

NRIC/Identification Document No
S/PINK S117610510

Address

FOR OFFICIAL USE

Relationship

FATHER

AIPT BLK 575 ANG MO KIO AVENUE 10 #08-1867
SINGAPORE 560575

THE CHILD IS A CITIZEN OF SINGAPORE AT THE TIME OF BIRTH
I certify that the above information given by me is correct.

Informant's Signature or Thumb impression

11/08/2001
Date

NURASHIKIN BT A BAKAR
for Registrar of Births and Deaths

11/08/2001 Date

ROSALES WESLEYAN ACADEMY, INC.

San Pedro West, Rosales, Pangasinan
Tel. (075) 582-2710

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
Principal

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