NCIP COC Form 3
Republic of the Philippines
NATIONAL COMMISSION ON INDIGENOUS PEOPLES
Cordillera Administrative Region
Province of
AD/Municipality of
AD/Barangay of
CERTIFICATION
This is to certify that Mr/Ms _________________________________________________ of
_____________________________________________ who is personally known to me to be
(address)
the child of _____________________________ and __________________________, belongs
(father) (mother -maiden name)
to the ______________________ ethnolinguistic group of ____________________________.
(IP group) (place of origin)
This is also to certify that his/her
1. FATHER: ________________________________ belongs to the ___________________
ethnolinguistic group of ___________________________________.
(place of origin)
2. MOTHER: ________________________________ belongs to the ___________________
ethnolinguistic group of ____________________________________.
(place of origin)
(This portion is to be filled up if the applicant is not included in the recognition book /census of the list of
beneficiaries of the ancestral domain)
This is to further CERTIFY AND ATTEST that that the above named person and his family are
beneficiaries of ______________________________________ ancestral domain but was not
(name of ancestral domain e.g. Happy Hallow)
included in the [ ] RECOGNITION BOOK (for those with recognition book)
[ ] CENSUS (for AD with no recognition book yet)
due to the following reasons:
___________________________________________________________________________
___________________________________________________________________________.
____________________________________
IP ELDER/LEADER/IPMR
Subscribed and sworn to before me this ________day of ________________________,
202__ at ______________________________________, Philippines.
Doc. No. _____
Page No. _____
Book No. _____
Series 202___ _______________________________________
Notary Public / Person Administering Oath
