LYKA MAE Q.

DUCULAN

#44 Purok 1, Bungro

San Fernando City, La Union 2500

Philhealth La Union
Quezon Avenue, San Fernando City,
La Union

To whom it may concern,

I, LYKA MAE Q. DUCULAN hereby authorize my mother, Melanie S. Quibin,

to be able to get a copy of my MDR and proof of payment at your office. I have my
work and I will be unable to get it myself.

Thank you for your consideration and assistance in this matter.

Signed By:

LYKA MAE Q. DUCULAN

09501087217
Unlockcode578@yahoo.com
To,
Philippine Statistics Authority
Biday, San Fernando City, La Union

Respected Sir / Ma’am,

I, Rey Mark B. Duculan, in my complete knowledge authorize my mother, Remalin B.

Duculan to get my documents Corrected Birth Certificate on my behalf as I am at
work.

Thank you and I am hoping for your cooperation. God bless!

Yours Sincerely,

Rey Mark B. Duculan

09295248999