Republic of the Philippines

MUNICIPALITY OF UMINGAN

BARANGAY CABALITIAN
OFFICE OF THE PUNONG BARANGAY
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CERTIFICATION

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that ______________________________, _____ years old, has not

developed any COVID-19 symptoms for the past fourteen days (14) days.

CERTIFYING further that, he/she is not listed as PUM nor PUI in this barangay.

Signed this ____th day of __________________,2020 at Brgy. Cabalitian, Umingan,

Pangasinan.

CERTIFIED BY;

______________________
Punong Barangay