Maritime Academy of Asia and the Pacific-Kamaya Point

Associated Marine Officers’ and Seamen’s Union of the Philippines-PTGWO-ITF

Kamaya Pt., Brgy. Alas-asin, Mariveles, Bataan

** LETTER FORMAT FOR MEDICAL PASS**

(DD MONTH YYYY)

FOR : DIRECTOR, DEPARTMENT OF MIDSHIPMEN AFFAIRS

FROM : MIDN (RANK) (LAST NAME, FIRST NAME, AND MIDDLE INITIAL)
THRU : FLEET MEDICAL OFFICER & FLEET PERSONNEL OFFICER
SUBJECT : REQUEST FOR MEDICAL PASS

Sir,

1. The undersigned midshipman would like to request from your good office an approval for
the request of Medical Pass for the purpose of (STATE YOUR PURPOSE FOR
APPLYING MEDICAL PASS AND DESTINATION.)

2. Attached herewith are the following letters:

a. The letter for excuse from classes noted by the instructors concerned and approved
by the Dean of Academics.
b. Referral slip/ letter from the Infirmary, including the date and place of consultation.

3. If approved, the said leave will commence at (STATE THE DURATION WITH
REGARDS TO TIME AND DATE.)

4. The said midshipman is not serving any restrictions.

5. Hoping for your kind consideration and approval sir.

Requested by:
___________________________
(LAST NAME, FIRST NAME, M.I)
MIDN (RANK) “_” COY

Noted by:

___________________________
(LAST NAME, FIRST NAME, M.I
MIDN 1CL “A” COY
COMPANY COMMANDER

Approved/ Disapproved:

__________________
GERLO L ELCHICO
CAPT PN (RET)
DIRECTOR, DMA

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