_________________________

Date

TO:
Ormoc City

RE: AUTHORIZATION LETTER

To Whom It May Concern:

THIS IS TO AUTHORIZE the bearer _________________________________________, of legal

age, to purchase medicines in my behalf for my illness maintenance and medications.

ISSUED this ____________ day of _____________________________, 2020 at

_______________________________________, Philippines

_____________________________________
Signature Over Printed Name of Senior Citizen
OSCA ID No. _________________________
Issued in _____________________________

Medicines Paid Per VSI# ____________

Date _____________________________

_________________________
Date

TO: LUZ PHARMACY

Ormoc City

RE: AUTHORIZATION LETTER

To Whom It May Concern:

THIS IS TO AUTHORIZE the bearer _________________________________________, of legal

age, to purchase medicines in my behalf for my illness maintenance and medications.

ISSUED this ____________ day of _____________________________, 2020 at

_______________________________________, Philippines

_____________________________________
Signature Over Printed Name of Senior Citizen
OSCA ID No. _________________________
Issued in _____________________________

Medicines Paid Per VSI# ____________

Date _____________________________