Republic of the Philippines

Province of Southern Leyte

Municipality of Libagon

-oOo-

Municipal Health Office

CERTIFICATION

To Whom It May Concern:

This is to certify that MR. ________________________________, ____ years old, male,

a resident of Barangay ___________, Libagon, Southern Leyte. He is not Suspected, Probable,
or a Confirmed case of Covid – 19.

This certification is being issued upon the request of the above mentioned name for
whatever legal purpose it may serve. Given this _____ day of ____________ 2020, at Libagon
RHU – Talisay, Libagonn, Southern Leyte.

IVY LIZA B. LOQUINTE, MD

Municipal Health Officer