INCIDENT REPORT

November 29, 2022

Dear Ma’am/Sir,

I am writing this letter as an official notice that Jess Christian V. Belando, a member of my

combative team category and one of my athletes in the Pencak Silat event, was injured while
competing during the MASTS 2022 held at Mati City last November 13, 2022, at 9:25 am. During
the aforementioned accident, he mistakenly used his left arm as a support during his takedown.
As his coach, I immediately notified the first aid crew to help and then transported him to the
closest hospital to ensure he got the proper care. He sustained a fracture in his left arm as a
result of the incident.

Attached herewith are the pictures as proof of the said accident:

Thank you so much for your assistance over this matter and if you need clarification as his
coach, please contact me at 09638198114 or email me at bklandawe@usm.edu.ph and I will
respond accordingly.

Regards,

BAE KELLAH KASSANDRA A. LANDAWE

Pencak Silat Coach

Noted:

Moreno B. Java Jr
ISPEAR Dean

Noted:

MARLON A. MANCERA
Sports Director