Republic of the Philippines

National Police Commission

PHILIPPINE NATIONAL POLICE, POLICE REGIONAL OFFICE 7
CEBU POLICE PROVINCIAL OFFICE
SOGOD POLICE STATION
Sogod, Cebu

October 14, 2021

FOR: DUTY PHYSICIAN

Sogod District Hospital
Damolog, Sogod, Cebu

SUBJECT: Request for Physical/Medical Examination

G R E E T I N G S:

Sir/Madam:

The undersigned respectfully requests your good office for a Physical/Medical Examination
of one RENEBOY COMABIG, 37 years old, DOB: January 06, 1984, Filipino, male, married and a
resident of Sitio Canduwang, Brgy. Liki, Sogod, Cebu who was allegedly involved in a vehicular
incident transpired on or about 07:19 in the evening of October 14, 2021 (Thursday) along the
national hi-way of Barangay Damolog, Sogod, Cebu.

Further requests to furnish this office result of the examination for record purposes and for
our future references.

Thank you very much.

FOR THE OFFICER IN CHARGE:

PCpl Josereden Hortelano

Duty PNCO
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Date:__________________

MEDICAL CERTIFICATE

Record No:___________

Name:_________________________________________ Age:________________

Sex:__________ Civil Status:____________Address:________________________

FINDINGS:

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(Attending Physician)
License No.______________