Republic of the Philippines
Province of Samar
Municipality of STA. MARGARITA
MUNICIPAL HEALTH OFFICE
JULY 27, 2020
MEDICAL CERTIFICATE
This is to certify that ________________, 27 y/o, a resident of Brgy. Tinabocan, Sta. Margarita,
W. Samar is NOT a COVID-19 suspect, probable, or confirmed.
Purpose of Travel: TO BUY GOODS AND BASIC NECESSITIES
_________________________________
Municipal Health Officer
Lic. No. 111111