Republic of the Philippines

DEPARTMENT1OF EDUCATION
________________________
(Region)
South Cotabato
(Division)
Palkan National High School
(School)
Palkan, Polomolok South Cotabato
(School Address)

MEDICAL CERTIFICATE

May 10, 2024

(Date)

To Whom It May Concern:

This is to certify that I have personally examined ROBERTO B. GREGORIO

Name
age 49 sex MALE born on NOVEMBER 12, 1974 and have found that he/she is
physically fit, during the time of examination, to join and officiate in the 2024
SOCCSKSARGEN REGIONAL ATHLETIC ASSOCIATION (SRAA) MEET.

Event: WRESTLING
Physical Examination

Date examined: _______________

Height Weight: Blood Pressure
Pulse, Resting Respiratory Rate
Other Remarks:

____________________________
Physician/Medical Officer
(Signature over printed name)

License No. __________________

PTR.: ____________________
Date: ___________________

FOR PALARONG PAMBANSA ONLY