Republic of the Philippines

Province of Samar
Municipality of STA. RITA
Barangay TULAYAN

CERTIFICATION
TO WHOM IT MAY CONCERN:

THIS IS TO CERTIFY that Mr. ____________, 25 years old and a bonafide resident of Barangay
TULAYAN, STA. RITA, Samar is under home quarantine due to lockdown imposed in our barangay starting
September 14, 2020 to September 25, 2020.

This certification is issued upon the request of the aforementioned name for all purposes it may
serve him best.

Issued on October 8, 2020 at Brgy. TULAYAN, STA. RITA, Samar.

HON. ________________ Jr.

Barangay Chairman