Republic of the Philippines

DEPARTMENT OF EDUCATION
XII
(Region)
COTABATO
(Division)
ALEOSAN NATIONAL HIGH SCHOOL
(School)
ALEOSAN, COTABATO
(School Address)

M E D I CAL C E R T I FI CAT E

________________
(Date)

To Whom It May Concern:

This is to certify that I have personally examined __JUN JR C. ALTIMO__________.

Name

Age _17 sex _MALE____ born on ___FEBRUARY 10, 2001 and have found that he/she is

physically fit, during the time of examination, to join and compete in the lower meets and

Congressional Meet 2017.

Event: _____CHESS________

Physical Examination:___________________

Date examined: _______________

Height Weight: Blood Pressure
Pulse, Resting Respiratory Rate
Other Remarks:

____________________________
Physician/Medical Officer
(Signature over printed name)

License No. __________________

PTR.: ____________________
Date: ____________________

FOR PALARONG PAMBANSA ONLY