ALETHEA R.

DE GUZMAN, MD MCHM, PHSAE

Director IV
Epidemiology Bureau
Department of Health

Dear Director De Guzman:

Our facility, (name of facility), located at (address), would like to express our intent to
register to the Synchronized Electronic Immunization Repository (SEIR). In line with this, we
hereby appoint and authorize the following personnel to manage the account of our health
facility:

1. (Complete Name, Position, Department) - email address and contact number

2. (Complete Name, Position, Department)- email address and contact number
3. (Complete Name, Position, Department) - email address and contact number

Finally, the aforementioned authorized personnel shall be accountable in managing and

securing all data processing through SEIR.

Thank you very much.

Very truly yours,

Name and Signature of Head of Health Facility