Republic of the Philippines

Department of the Interior & Local Government Control #________

REGION X
Province of Lanao del Norte
Municipality of Kauswagan
Barangay Poblacion

OFFICE OF THE PUNONG BARANGAY

------------------------------------------------------------------------------------------------------------------------------
BARANGAY CERTIFICATION

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that_________________________________________,____ years old,

a resident of Purok_____, Poblacion, Kauswagan, Lanao del Norte has not developed any COVID-19
symptoms at least 14 days before the travel request.

This serve as an endorsement for Medical Clearance.

Purpose of Travel:___________________________________________________________

Issued this____th day of October , 2021.

One day pass only . Date of Travel____________________,2021

HON. ANGELO M. ACASO

Punong Barangay

Republic of the Philippines

Department of the Interior & Local Government Control #_________
REGION X
Province of Lanao del Norte
Municipality of Kauswagan
Barangay Poblacion

OFFICE OF THE PUNONG BARANGAY

------------------------------------------------------------------------------------------------------------------------------
BARANGAY CERTIFICATION

TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that_________________________________________,____ years old,

a resident of Purok_____, Poblacion, Kauswagan, Lanao del Norte has not developed any COVID-19
symptoms at least 14 days before the travel request.

This serve as an endorsement for Medical Clearance.

Purpose of Travel:____________________________________________________________

Issued this____th day of October, 2021.

One day pass only. Date of Travel:__________________,2021

HON. ANGELO M. ACASO

Punong Barangay