Republic of the Philippines Republic of the Philippines

Department of Health Department of Health

Regional Health Office No. 5 Regional Health Office No. 5
1 OFFICE OF THE 2 OFFICE OF THE
MUNICIPAL HEALTH OFFICER MUNICIPAL HEALTH OFFICER
Baao, Camarines Sur Baao, Camarines Sur

HEALTH CERTIFICATE HEALTH CERTIFICATE

Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856 Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856
This certificate is issued to This certificate is issued to

NAME: ________________________________________________________________ NAME: ________________________________________________________________

OCCUPATION: _________________________________ AGE: ______ SEX: _______ OCCUPATION: _________________________________ AGE: ______ SEX: _______
NATIONALITY: ________________ PLACE OF WORK: _________________________ NATIONALITY: ________________ PLACE OF WORK: _________________________
SIGNATURE: _____________________ SIGNATURE: _____________________

MARIAM G. MARGATE, MD MARIAM G. MARGATE, MD

Municipal Health Officer Municipal Health Officer
Baao, Camarines Sur Baao, Camarines Sur

Republic of the Philippines Republic of the Philippines

Department of Health Department of Health
Regional Health Office No. 5 Regional Health Office No. 5
3 OFFICE OF THE 4 OFFICE OF THE
MUNICIPAL HEALTH OFFICER MUNICIPAL HEALTH OFFICER
Baao, Camarines Sur Baao, Camarines Sur

HEALTH CERTIFICATE HEALTH CERTIFICATE

Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856 Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856
This certificate is issued to This certificate is issued to

NAME: ________________________________________________________________ NAME: ________________________________________________________________

OCCUPATION: _________________________________ AGE: ______ SEX: _______ OCCUPATION: _________________________________ AGE: ______ SEX: _______
NATIONALITY: ________________ PLACE OF WORK: _________________________ NATIONALITY: ________________ PLACE OF WORK: _________________________
SIGNATURE: _____________________ SIGNATURE: _____________________

MARIAM G. MARGATE, MD MARIAM G. MARGATE, MD

Municipal Health Officer Municipal Health Officer
Baao, Camarines Sur Baao, Camarines Sur

Republic of the Philippines Republic of the Philippines

Department of Health Department of Health
Regional Health Office No. 5 Regional Health Office No. 5
5 OFFICE OF THE 6 OFFICE OF THE
MUNICIPAL HEALTH OFFICER MUNICIPAL HEALTH OFFICER
Baao, Camarines Sur Baao, Camarines Sur

HEALTH CERTIFICATE HEALTH CERTIFICATE

Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856 Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856

This certificate is issued to This certificate is issued to

NAME: ________________________________________________________________ NAME: ________________________________________________________________

OCCUPATION: _________________________________ AGE: ______ SEX: _______ OCCUPATION: _________________________________ AGE: ______ SEX: _______
NATIONALITY: ________________ PLACE OF WORK: _________________________ NATIONALITY: ________________ PLACE OF WORK: _________________________
SIGNATURE: _____________________ SIGNATURE: _____________________

MARIAM G. MARGATE, MD MARIAM G. MARGATE, MD

Municipal Health Officer Municipal Health Officer
Baao, Camarines Sur Baao, Camarines Sur

Republic of the Philippines Republic of the Philippines

Department of Health Department of Health
Regional Health Office No. 5 Regional Health Office No. 5
7 OFFICE OF THE 8 OFFICE OF THE
MUNICIPAL HEALTH OFFICER MUNICIPAL HEALTH OFFICER
Baao, Camarines Sur Baao, Camarines Sur

HEALTH CERTIFICATE HEALTH CERTIFICATE

Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856 Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856
This certificate is issued to This certificate is issued to

NAME: ________________________________________________________________ NAME: ________________________________________________________________

OCCUPATION: _________________________________ AGE: ______ SEX: _______ OCCUPATION: _________________________________ AGE: ______ SEX: _______
NATIONALITY: ________________ PLACE OF WORK: _________________________ NATIONALITY: ________________ PLACE OF WORK: _________________________
SIGNATURE: _____________________ SIGNATURE: _____________________

MARIAM G. MARGATE, MD MARIAM G. MARGATE, MD

Municipal Health Officer Municipal Health Officer
Baao, Camarines Sur Baao, Camarines Sur