Republic of the Philippines

Barangay yyy Zone xx

------------- St., Malate, 5th District
City of Manila
OFFICE OF THE PUNONG BARANGAY

October 1, xxxx

MR. JUAN DEL ACRUZ

Vice Chairperson and General Manager
Government Office St,. cor.
Mandaluyong City

Subject : Indorsement Letter

In Re:

Dear ________________,

This is to indorse to your good office the bearer, _______________________, a senior

citizen, a widow and a bona fide resident of this Barangay who is presently residing at
_____________ St., Malate, Manila for the purpose of availing for Medical
Assistance Program (IMAP).

The bearer belongs to an indigent family or a low income earner in this Barangay and
not even a pensioner of SSS or GSIS.

Please see attached photocopies of her senior citizen’s ID and her medical records as
well as the certificates of residency and indigency issued by this office for your
reference.

We look forward for your kind consideration and approval of this request in favor of
the bearer/applicant

Sincerely,

___________________________
Punong Barangay