QCG.BPLD.BPD.F.

04 (2023)

Occupational Permit No.: OP24-0071802

Name of the Applicant: ALEX MAR EVANGELISTA BUSTALINIO

Address: # 4 KEDAR JORDAN HEIGHTS ST., BRGY.

NAGKAISANG NAYON QUEZON CITY, NCR, 1125

Date of Birth: 04/15/2000

Age: 24

Gender: MALE/SINGLE

Nationality: FILIPINO

Work Title: INVENTORY CLERK

Signature of Applicant

ATTACHMENTS

Official Receipt Police / NBI Clearance Health Certificate

Date Issued: Official Receipt No.: Police / NBI Clearance No.: Health Certificate No.:
06/07/2024 M-2024-000-268-0016509 41426913
Valid Until: Date of Payment: Date Issued: Date Issued:
06/07/2025 06/07/2024 06/05/2024

Remarks: To comply with Health Certificate requirement of the QCHD as mandated under Chapter II, Section 4 of City Ordinance SP-2503, S-2016.

For and by the Authority of the City Mayor:

MA. JOSEFINA G. BELMONTE
APPLICABLE LAWS:
1. Article 22 of the Quezon City Revenue Code.
2. Joint Memorandum Circular No.: 01 Series of 2021.
WARNING:
Faking, Forging or Tampering this document is punishable
by law and shall be dealt with accordingly!
MA. MARGARITA T. SANTOS, DPA
City Government Department Head III

ANY ERASURE/ALTERATION WILL INVALIDATE THIS PERMIT