Annex "A"

Letter Head of the Institution/Agency/Entity

(with address and contact details)

CERTIFICATION

I, ____________, (designation), a duly authorized officer of

institution/agency/entity do certify that __________________, an
employee/official/resident/consultant/volunteer herein was assigned / provided
outstanding services, as ________________ at ______(place)__________________
from ____(period)_____________ during the State of Public Health Emergency brought
about by the Corona Virus Disease 2019 (COVID-19)
As such, he/she (details of functions/ tasks/accomplishment/)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
_________________________________________________________________.
This is issued for his/her Continuing Professional Development compliance
application and other legal purposes it may serve.

This ____ day of ______________ at _____________________.

Signature over printed name

(Designation)

SUBSCRIBED and sworn to before me, a Notary Public for _______________,

Affiant exhibiting before me his/her government issued identification card __________,
issued at ________________ on ___________________.

This _____ day of ___________ at ____________________.

Notary Public

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