PREMIUM MEGASTRUCTURES INC.

1423 The Mondrian Bldg. Pablo Ocampo Sr. Ext.

San Antonio Village, Makati City 1203 Philippines
Tel. Nos. (02) 744-5264 / 576-8546

Reference No: EHS-LOA-MYP-01 (Change this according to our Document Code Guideline)

Date : September 28, 2023

To : NAME OF HOSPITAL
Exact address of the hospital

From : PROJECT MANAGER/ PROJECT IN-CHARGE

Project Name

Subject : Letter of Authorization to Mr/Ms. NAME OF PATIENT

Greetings!

This is to formally endorse Mr./ Ms. ______________________________________ for the following medical
attention:

Ancillary Procedures
Out-Patient/ Consultation
Emergency Room availment
In-Patient
Surgery/ Operation
Confinement
Others (Please specify): __________________

All medical expenses for the aforementioned patient shall be paid in accordance to the agreement with the
hospital and to Premium Megastructures Inc.

Thank you for your assistance.

Endorsed and authorized by:

NAME OF PROJECT MANAGER/ PROJECT IN-CHARGE

Position