Republic of the Philippines Republic of the Philippines

Province of Aurora Province of Aurora

Municipality of San Luis Municipality of San Luis
BARANGAY DITUMABO BARANGAY DITUMABO
___________________________________________________________________________ ___________________________________________________________________________
BARANGAY CERTIFICATE OF ACCEPTANCE BARANGAY CERTIFICATE OF ACCEPTANCE

TO WHOM IT MAY CONCERN: TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY THAT, ________________________________________, THIS IS TO CERTIFY THAT, ________________________________________,

_____ years old, male/female, single/married/widow/widower, is a bona fide
resident of _____________________________________.
FURTHER CERTIFIES THAT, we are accepting him/here in our barangay
subject to the following restriction provided by the Municipal Inter-Agency Task
Force (MIATF) of San Luis, Aurora:
_____ years old, male/female, single/married/widow/widower, is a bona fide
resident of _____________________________________.
FURTHER CERTIFIES THAT, we are accepting him/here in our barangay
subject to the following restriction provided by the Municipal Inter-Agency Task
Force (MIATF) of San Luis, Aurora:

___ day Mandatory Quarantine at the Barangay Facility
14-day Mandatory Quarantine at the Barangay Facility
Mandatory Strict Home Quarantine (14 days)
(conduct house visit for approval of MHO personnel)
For BHERT Monitoring
With Rapid Test Antigen positive (+) result: Date _________
With RT-PCR positive (+) result: Date _______________
___ day Mandatory Quarantine at the Barangay Facility
14-day Mandatory Quarantine at the Barangay Facility
Mandatory Strict Home Quarantine (14 days)
(conduct house visit for approval of MHO personnel)
For BHERT Monitoring
With Rapid Test Antigen positive (+) result: Date _________
With RT-PCR positive (+) result: Date _______________

This certification is being issued upon the request of the above-named for This certification is being issued upon the request of the above-named for
transfer to the Barangay Quarantine/Home Quarantine and for any legal purposes transfer to the Barangay Quarantine/Home Quarantine and for any legal purposes
this may serve. this may serve.

ISSUED this ____ day of _________________, 2021 in the Barangay ISSUED this ____ day of ________________, 2021 in the Barangay Ditumabo,
Ditumabo, San Luis, Aurora. San Luis, Aurora.
ATTESTED BY: ATTESTED BY:

SHERWIN V. MACATIAG SHERWIN V. MACATIAG

Punong Barangay Punong Barangay
Issued by: Issued by:

JASMIN M. MAMUGAY JASMIN M. MAMUGAY

BHERT BHERT