Republic of the Philippines

BANGSAMORO AUTONOMOUS REGION IN MUSLIM MINDANAO

Ministry of Basic, Higher, and Technical Education

______________________________
(Division)
______________________________
(School)
______________________________
(School Address)

MEDICAL CERTIFICATE
__________________
(Date)
To Whom It May Concern:

This is to certify that I have personally examined ____________________________

Name
age ______ sex _____ and have found that he/she is physically fit unfit to play,

during the time of examination, to join and participate in the 2022 BARMAA LIMITED

FACE TO FACE INVITATIONAL TOURNAMENT.

Event: ___________________________

Physical Examination

Date examined: _______________

Height: Weight: Blood Pressure:
Pulse, Resting Respiratory Rate:

Remarks/Findings:

Ht ._____________________________ FIT TO PLAY

Wt._____________________________
_______________________________________ BP:_____________________________ UNFIT TO
_ Physician/Medical Officer PLAY
BR:_____________________________
(signature over printed name)
PRC:
LICENSE: PTR NO.