DATE

CERTIFICATION OF KASAMBAHAY FOR

QUARANTINE PASS

TO WHOM IT MAY CONCERN:

This is to certify that ______(kasambahay name)___________________ is connected

with our household located at _________(address of
household)_____________________________ as a kasambahay. ____(kasambahay
name)_____________________ is originally from ___(home of kasambahay)___ and this
certification is issued to him/her for purposes of securing a quarantine pass in order
to return safely to our household located at ______(address of household)______.

This certification is issued for whatever legal purpose it may serve and for
purposes of allowing her safe travels as she goes through the various checkpoints in
the different municipalities.

Certification issued by:

__(employer)____
Head of the Household
___(Address of the household)

Notes on the Home Quarantine Pass Rule:

1.) the Home Quarantine Pass is issued so that people may go out of their homes
for personal purposes and not for work-related purposes.
2.) A Worker’s Pass is issued to allow someone to go out of their homes in order
to report for work in establishments which are considered “essential.”
3.) Essential establishments are those allowed to open or operate during the
period of the enhanced community quarantine.
4.) The enhanced community quarantine may have differing applications in each
local government unit as there are differing executive orders issued by heads
of local governments.