To whom it may concern:

THIS IS TO CERTIFY that ______________________________,

(FAMILY NAME, GIVEN NAME, MIDDLE NAME) _________,
(GENDER)

______ (ADDRESS)
(AGE) years of age, a resident of _______________________________________

has SUCCESSFULLY COMPLETED the prescribed 14-DAY home-quarantine from

(START OF QUARANTINE) to __________________.
_________________ (END OF QUARANTINE)

This is to FURTHER CERTIFY that during the above-mentioned quarantine

period up to date of certification, there were no display of any common symptoms of
COVID-19. This certification is being issued to the above-mentioned person for the
requirement to take the Licensure Examination for ___________________________.

Issued this _____ day of ________, 2021 at ___________________________.

Issued by,

_____________________
Attending Physician
License No. ___________

Or

_____________________
Punong Barangay