Republic of the Philippines

Province of Aurora
MUNICIPALITY OF SAN LUIS

BARANGAY CERTIFICATE OF ACCEPTANCE

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY THAT, MR./MRS./MS.,

__________________________, _____ years old, male/female,
single/married/widow/widower, is a bona fide resident of Barangay 04 Poblacion,
San Luis, Aurora.

FURTHER CERTIFIES THAT, he/she is a Locally Stranded Individual (LSI)

from _________________________________________________ and
that we are accepting him/her in our barangay subject to the following restrictions
provided by the Municipal Inter-Agency Task Force (MIATF) of San Luis, Aurora:

_____-day Mandatory Quarantine at the Barangay Facility

14-day Mandatory Quarantine at the Barangay Facility
Mandatory Strict Home Quarantine (14 days)
(conduct house visit for approval of MHO personnel)
Others: (Specify) ___________________________________________

This certification is being issued upon the request of the above-named for
transfer from LGU Quarantine Facility to the Barangay Quarantine Facility and for
any legal purpose this may serve.

ISSUED this _____ day of ________________ 2021 in Barangay 04

Poblacion, San Luis, Aurora.

Attested by:

HIPOLITO B. GARCIA, JR.

Punong Barangay

____________________________
MDRRMO

____________________________
 Republic of the Philippines
Province of Aurora
MUNICIPALITY OF SAN LUIS

MHO