REPUBLIC OF THE PHILIPPINES 
CALOOCAN CITY SOCIAL WELFARE DEPARTMENT 
 
New   
Renewal               Solo Parent #: __________ 
Date___________  Picture 
APPLICATION FOR SOLO PARENT 
 
Barangay_____UNIT ___DISTRICT_____ 
Name:__________________________________________ Age:_____ Sex:______ 
Date of Birth :_____________________Place of Birth:_____________________ 
Address:____________________________________________________  ______                                     
Educational Attainment:________________________________________                     
  Philhealth3        4Ps member   
 
Children : ( 18 and below) 
Name  Relationship Age Status Educational Attainment  Birthdate
   
   
   
   
   
 
I. Classification / Circumstances of Being a Solo parent (pls check one) 
Unwed            Separated              Widow          Abandoned           Annulled  
        Husband / Wife in jail         Husband / Wife PWD  Poster Parent/Guardian 
 
II. Circumstances: ( state situation ) 
___________________________________________________________________________________
___________________________________________________________________________________ 
III. Needs and problems of Solo parent(financial/job/legal/counseling/ NHA/ Educational) 
___________________________________________________________________________________ 
IV. Family Resources 
Unemployed 
Source of Income : Kind of Work:________________________________ 
  Employed ‐      Contractual      Permanent           Seasonal 

5,000 – 10,000       
10,000 – 20,000 
20,000 – 30,000     
30,000 – 40,000 
 
V. Name / Address of Company/ tel no.:__________: ____________________________________ 
 
I HEREBY CERTIFY THAT THE INFORMATION GIVEN ARE TRUE AND CORRECT. I FURTHER UNDERSTAND THAT 
ANY MISINTERPRETATION THAT MAY HAVE MADE WILL SUBJECT ME TO CRIMINAL AND CIVIL LIABILITIES 
PROVIDED FOR BY EXISTING LAWS. 
 
DATE:________________  Signature:____________________Contact NO.:_____________________ 
 
Interviewed by:______________________________Unit ______ 
Application Received by:___________________________________ Date:____________________ 
Assistance:_______________________________________________________________________ 
 
Remarks : 
 
 
 
 

 
 

TO ALL APPLICANTS : PLEASE ASK THIS CERTIFICATION FROM YOUR BARANGAY

TO: BARANGAY _____

FROM: CALOOCAN CITY SOCIAL WELFARE OFFICE
RE: Solo Parent Certification
Date: _________2018
==================================================================================

We believe that your office could help us identify the authenticity of Solo Parents Applicant. Hereby, may we respectfully request
your kind assistance to help us validate their present status by issuing them a certification certified by the Barangay Captain.

It is very important that applicant has minor children and no present relationship for him/ her to be considered a single parent.

In addition, may we also request your continued support on advocating this Solo Parent under Republic Act 8972.

Benefits of employed Solo Parent is the additional seven days leave credits with pay. And for those unemployed, our city Government
has livelihood trainings , job placements to offer.

Attached herewith, the sample of Certification with detailed information that will be very helpful for the approval of his/ her
application.

Thank you very much and More power!

MARILOU N. GALBAN, RSW

Caloocan City Social Welfare Officer
======================================================================================================= 

SAMPLE ONLY:  (with barangay logo) 

  This is to certify that _______________________, _____years old, presently residing at____________________________ of this 
Barangay is a Single Parent.  MR. /MS._______________________ is___________________. 

( kindly state the status of the applicant: see below categories of single parent) . His/ Her children, namely____________________________ is/ 
are under her /his custody.  

Upon, verification , he/she is not involved into a new relationship up to present which gives her consideration to be a certified solo 
parent. 

  This certification is being issued upon the request of Mr./Ms____________  for authentication of   client’s  present  status  to qualify  
to be a Solo  Parent. 

Issued this day of___________. 
            Barangay Captain 

Witnesses : 

____________________________________________ ____________ ________ __________ 
Name                   address       contact number  signature 
________________ ____________ ________ ______________________________________ 
Name                   address       contact number  signature 
 

Must be: Must be Single for a year already

¾ In case of widow/widower: submit death certificate
Must have children aged 18 years below
  ¾ In case of guardian / foster/adoption/parental case of 
Requirements: for new applicants and renewal    guardianship 
New:   
a. Submit an affidavit (legal) 
____1x1 picture applicant ‐ 1 PC for I.D.                             
____2x2 picture applicant – 2PC for CCSWD file  b. Brgy should indicate clearly the present situation  
____Birth Certificate of child/children (Xerox)  ¾ In case of wife/husband in jail 
____Brgy certification (from barangay – see above  a. Submit copy of court order 
sample) 2 copies 
¾ In case of wife/husband is a PWD 
         ____Completely filled up  
         ____Index Card size 1/2  a. Submit PWD id (Xerox) 
Renewal:   ¾ In case of child above 18 & a PWD  
          ____new barangay Certification of Solo Parent              a. Submit child PWD Id  
          ____1x1  id picture, Xerox old Solo parent id back 
                   To back 
 
 
Unit  I‐ II  Unit  III  UNIT IV UNIT V UNIT VI 
B1‐35,73,80  B1 81‐85  B179‐188  B165 – 175  Brgy176 
B 36 – 72, 74‐79, 86‐131  132‐150, 151‐164  177‐178 
Rose Marie Reyes‐ Focal  Ms. Regina Embalsado:  Ms.Mamerta Lucas  Ms. Milagros Sampang  Ms. Melanie Parrenas
Person  Unit in Charge  Unit In Charge  Unit In Charge  Unit In Ccharge 
ToToJalocon– staff  Zosima Sanchez ‐ staff  Cecile Lopez ‐ staff  MerlyBorlaza ‐ staff  Femy ‐ staff 
Marissa Reyes ‐ staff       
 
3365705    277 2931