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Republic of the Philippines

Province of Samar
Municipality of STA. MARGARITA

MUNICIPAL HEALTH OFFICE

JULY 27, 2020

MEDICAL CERTIFICATE

This is to certify that ________________, 27 y/o, a resident of Brgy. Tinabocan, Sta. Margarita,
W. Samar is NOT a COVID-19 suspect, probable, or confirmed.

Purpose of Travel: TO BUY GOODS AND BASIC NECESSITIES

_________________________________
Municipal Health Officer
Lic. No. 111111

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