Republic of the Philippines Republic of the Philippines

Province of Eastern Samar Province of Eastern Samar

City of Borongan City of Borongan
CITY HEALTH OFFICE CITY HEALTH OFFICE

ROAD/TRAVEL PASS ROAD/TRAVEL PASS

CITY OF BORONGAN CITY OF BORONGAN

The bearer; The bearer;

__________________________________________________ __________________________________________________
of___________________________is allowed to travel to of___________________________is allowed to travel to
______________________________. ______________________________.

Purpose of Travel; Purpose of Travel;

_______________________________________________. _______________________________________________.

Duration of road/travel pass;_________________________. Duration of road/travel pass;_________________________.

Issued this _______day of __________2020, City Health Issued this _______day of __________2020, City Health
Office of Borongan, Eastern Samar. Office of Borongan, Eastern Samar.

DR. DAISY G. SACMAR DR. DAISY G. SACMAR

City Health Officer City Health Officer