Republic of the Philippines

Department of Education

___________XI____________
Region

__________Davao City_________
Division
(Division)

MEDICAL CERTIFICATE
Date: September 20, 2019
To Whom It May Concern:
This is to certify that I have personally examined JAPHET D. PALABRICA
Name
Age __15___ sex ____Male_____ born on ______September 28, 2003_________ and have found
that he/she is physically fit, during the time of examination, to join and compete in the lower
meets (Unit meet).

Event: ________TABLE TENNIS______________

Physical Examination

Date Examined: _ September 20, 2019__

Height _____ ______ Weight ______ ___ Blood Pressure ____________

Pulse Resting ______________________________ Respiratory Rate________________
Other Remarks:
__________________ _______________________________________________________________

___________________________________________
Physical/Medical Officer
(Signature over printed name)
License No. ____________________
PTR: _________________________
Date: ________________________