Republic of the Philippines

Province of Northern Samar

MUNICIPALITY OF CAPUL

OFFICE OF THE MUNICIPAL MAYOR

_____________, 2021

HON . EDWIN MARINO C. ONGCHUAN

Governor
Province of Northern Samar
2nd Floor New Capitol Building , Brgy. Dalakit, Catarman

Dear Governor Ongchuan:

The undersigned hereby certifies

that________________________________________
of___________________________________ has no derogatory record in this Office as of
this date.

I certify further that I personally know __________________________________and

that I believe him/her to be person of a good moral character.

This certification is issued in relation to his/her application for employment in the

Provincial Government of Northern Samar.

Sincerely,

________________________________
Municipal Mayor