M E D I CAL C E RT I FI CAT E

JANUARY 28, 2019

(Date)

To Whom It May Concern:

This is to certify that I have personally examined JOVER III JUSTINE JONATHAN A.
Name

age 10 sex M born on March 3, 2008 and have found that he/she is physically fit, during

the time of examination, to player / chaperon / officiate and to compete in the lower meets

up to Palarong Pambansa,.

Event: Table Tennis

Physical Examination

Date examined: _______________

Height Weight: Blood Pressure
Pulse, Resting Respiratory Rate
Other Remarks:

____________________________
Physician/Medical Officer
(Signature over printed name)

License No. __________________

FOR PALARONG PAMBANSA ONLY