Apr

il20,
2022

Escual
a,Casi
gur
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Sor
sogon

DearMaam orSi
r,

I
,RosarioS.Sur banoofl egalage,bonaf i
deresi
dentofBrgy.EscualaCasiguran
Sorsogontoherebyaut hor
izedmybr otherJhonDav eS.Sur
bano.Il
ikewiseoflegalage
andresidentofBrgy.Escuala,
Casiguran,Sorsogontodoinmybehalftocontactinyour
goodofficebecauseIam injur
ed( Ri
ghtarm)duet oamot or
cycl
eaccident.

Hopi
ngf
ory
ourKi
ndhear
tedconsi
der
ati
oni
nthi
sregar
d.

Gi
vent
his20t
hdayofApr
il2022.

Si
ncer
elyy
our
s,

Rosar
ioS.Sur
bano

NameofPat
ient

JhonDav
eSur
bano

NameofAppl
i
cant