Republic of the Philippines Republic of the Philippines
Department of Health Department of Health
Regional Health Office No. 5 Regional Health Office No. 5
1 OFFICE OF THE 2 OFFICE OF THE
MUNICIPAL HEALTH OFFICER MUNICIPAL HEALTH OFFICER
Baao, Camarines Sur Baao, Camarines Sur
HEALTH CERTIFICATE HEALTH CERTIFICATE
Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856 Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856
This certificate is issued to This certificate is issued to
NAME: ________________________________________________________________ NAME: ________________________________________________________________
OCCUPATION: _________________________________ AGE: ______ SEX: _______ OCCUPATION: _________________________________ AGE: ______ SEX: _______
NATIONALITY: ________________ PLACE OF WORK: _________________________ NATIONALITY: ________________ PLACE OF WORK: _________________________
SIGNATURE: _____________________ SIGNATURE: _____________________
MARIAM G. MARGATE, MD MARIAM G. MARGATE, MD
Municipal Health Officer Municipal Health Officer
Baao, Camarines Sur Baao, Camarines Sur
Republic of the Philippines Republic of the Philippines
Department of Health Department of Health
Regional Health Office No. 5 Regional Health Office No. 5
3 OFFICE OF THE 4 OFFICE OF THE
MUNICIPAL HEALTH OFFICER MUNICIPAL HEALTH OFFICER
Baao, Camarines Sur Baao, Camarines Sur
HEALTH CERTIFICATE HEALTH CERTIFICATE
Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856 Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856
This certificate is issued to This certificate is issued to
NAME: ________________________________________________________________ NAME: ________________________________________________________________
OCCUPATION: _________________________________ AGE: ______ SEX: _______ OCCUPATION: _________________________________ AGE: ______ SEX: _______
NATIONALITY: ________________ PLACE OF WORK: _________________________ NATIONALITY: ________________ PLACE OF WORK: _________________________
SIGNATURE: _____________________ SIGNATURE: _____________________
MARIAM G. MARGATE, MD MARIAM G. MARGATE, MD
Municipal Health Officer Municipal Health Officer
Baao, Camarines Sur Baao, Camarines Sur
Republic of the Philippines Republic of the Philippines
Department of Health Department of Health
Regional Health Office No. 5 Regional Health Office No. 5
5 OFFICE OF THE 6 OFFICE OF THE
MUNICIPAL HEALTH OFFICER MUNICIPAL HEALTH OFFICER
Baao, Camarines Sur Baao, Camarines Sur
HEALTH CERTIFICATE HEALTH CERTIFICATE
Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856 Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856
This certificate is issued to This certificate is issued to
NAME: ________________________________________________________________ NAME: ________________________________________________________________
OCCUPATION: _________________________________ AGE: ______ SEX: _______ OCCUPATION: _________________________________ AGE: ______ SEX: _______
NATIONALITY: ________________ PLACE OF WORK: _________________________ NATIONALITY: ________________ PLACE OF WORK: _________________________
SIGNATURE: _____________________ SIGNATURE: _____________________
MARIAM G. MARGATE, MD MARIAM G. MARGATE, MD
Municipal Health Officer Municipal Health Officer
Baao, Camarines Sur Baao, Camarines Sur
Republic of the Philippines Republic of the Philippines
Department of Health Department of Health
Regional Health Office No. 5 Regional Health Office No. 5
7 OFFICE OF THE 8 OFFICE OF THE
MUNICIPAL HEALTH OFFICER MUNICIPAL HEALTH OFFICER
Baao, Camarines Sur Baao, Camarines Sur
HEALTH CERTIFICATE HEALTH CERTIFICATE
Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856 Registration No. ____ Pursuant to the Provision of P.D. 522, P.D. 856
This certificate is issued to This certificate is issued to
NAME: ________________________________________________________________ NAME: ________________________________________________________________
OCCUPATION: _________________________________ AGE: ______ SEX: _______ OCCUPATION: _________________________________ AGE: ______ SEX: _______
NATIONALITY: ________________ PLACE OF WORK: _________________________ NATIONALITY: ________________ PLACE OF WORK: _________________________
SIGNATURE: _____________________ SIGNATURE: _____________________
MARIAM G. MARGATE, MD MARIAM G. MARGATE, MD
Municipal Health Officer Municipal Health Officer
Baao, Camarines Sur Baao, Camarines Sur
