Sample request Format of Physical/Medical Examination

Republic of the Philippines

Department of the Interior and Local Government
NATIONAL POLICE COMMISSION
PHILIPPINE NATIONAL POLICE
_________________________________________
___________________________

MEMORANDUM

FOR : Director, PNP Crime Laboratory

FROM :

SUBJECT : Request for Physical/Medical Examination

DATE :

1. Request conducts Physical/Medical Examination of the person

____________________ residing at ________________________.

2. In connection with para 1 above, request furnish this office a copy of the initial
result thereof for reference purposes.

3. For consideration.

____________________________
(CHIEF OF OFFICE)