Republic of the Philippines

Province of _____________________
Municipality of __________
BARANGAY _______________________

Office of the Punong Barangay

CERTIFICATION

To Whom It May Concern:

This is to certify that _____________________________, _______ years old
and bona fide resident of _________________________________

This certification is issued upon the request for travel as indicated below, subject
to restrictions imposed by Luna Police Station and Luna Rural Health Unit.

Date of Travel
Place of Origin
Destination
Vehicle
Plate Number
Purpose of Travel
CP Number
Traveler
Classification

This certification is only for the purposes of securing Health Certificate and PNP
Travel Authority.

Given this _____ day of __________ in Barangay ______, ________, ________.

__________________
Punong Barangay