Republic of the Philippines

Quezon City Health Department

DIGITAL HEALTH CERTIFICATE

Signature

Pursuant to P.D. 856 and QC Ordinance SP 2503 S-2016, this

certificate is issued to

NAME: Nicole Jhon R Rivas sibayan

AGE: 21 SEX: M NATIONALITY: Philippines

HOME ADDRESS: 18 Mother Ignacia Paligsahan Quezon City

OCCUPATION: Service Crew INDUSTRY: Food

SPUTUM/CXR: NEGATIVE STOOL: NEGATIVE

REGISTRATION NO.: IHC-20240414-01035517

APPROVED: Online Validation

RAMONA ASUNCION DG. ABARQUEZ M.D. MPH

OIC QUEZON CITY HEALTH DEPARTMENT

This is computer generated document.

No signature is required. VALID UNTIL 04/13/2025