Republic of the Philippines

Bangsamoro Autonomous Region in Muslim Mindanao

MINISTRY OF SOCIAL SERVICES AND DEVELOPMENT

PROVINCE OF LANAO DEL SUR B

SULTAN DUMALONDONG, L ANAO DE SUR

Certification
THIS IS TO CERTIFY that___________________________________________ has been
assessed in accordance with DOH classification on Indigence/ DSWD Assessment Tool
as:

Financially capable

Financially incapable

This certification is issued fort he purpose of availment of the of the above named patient
according to the provision of General Appropriation Act of 2019.

Issued on __________________ 2021 at MSSD Sutan Dumalondong Unit Office, Sutan

Dumalondong Lanao Del Sur.

NORSALIMAH P. SAIPODIN, RSW

Municipal Social Welfare Officer

License No.: 0023609