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Republic of the Philippines

Department of Education
XII
(Region)
Kidapawan City
(Division)
Photo
passport size
(School)

(Address)

MEDICAL CERTIFICATE
Date : JANUARY 26, 2023
To Whom It May Concern:

This is to certify that I have personally examined MR. ELIEZER B. ELMAN age 57
sex MALE born on JANUARY 10, 1966 and have found that he is physically
fit, during the time of examination to join in the SRAA 2023 Officiating Officials Refresher
Course to be held in Lebak, Sultan Kudarat on January 31, 2023 to February 3, 2023

Event:

Physical Examination

Date Examined :
Height Weight Blood Pressure

Pulse, Resting Respiratory Rate

Other Remarks:

Physician/Medical Officer

License No.:
PTR:
Date:

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