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FORM TYPE: Travel Coordination Permit

QR: LGU-388DBE21350387-06-01


NAME: Gladys Rosal

Traveller Type: Returning Residents

Origin: CEBU CITY,CEBU CITY

Origin BRGY: 42h cabarrubias hts tisa cebu city

STATUS: APPROVED Destination: SAGAY CITY,NEGROS OCCIDENTAL

Destination BRGY: Poblacion 2 sagay city

Date of Travel: 2021-06-02

Date of Expected Arrival: 2021-06-02

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NEGROS OCCIDENTAL, REGION VI WESTERN VISAYAS

Date: June 1, 2021

Travel Coordination Permit

This travel coordination permit is granted to the person listed below to pass at the established Quarantine
Control Points (QCPs), Checkpoints, Seaports and Airports from point of origin to point of destination.

Name: Gladys Dy Rosal


Type of Traveller: Returning Residents

Date of Travel: June 2, 2021 to June 2, 2021


Place of Origin: CEBU CITY, CEBU CITY

Origin Barangay: 42h cabarrubias hts tisa cebu city

Place of Destination: SAGAY CITY, NEGROS OCCIDENTAL

Destination Barangay: Poblacion 2 sagay city

Mode of Transportation: Land (private)

Additional Travel Details:

Remarks: NA

EUGENIO JOSE V. LACSON


Governor
Province of Negros Occidental

LGU-388DBE21350387-06-01

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