DSWD Assistance Provincial Form

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Republic of the Philippines

Province of Sorsogon
Municipality of Sta. Magdalena
BARANGAY 2 POBLACION

OFFICE OF THE PUNONG BARANGAY

BARANGAY INDIGENCY

To whom it may concern:

This is to certify that KATRINA E. DAYMON, of legal age, married,


Filipino, a resident of Barangay 2, Poblacion, Sta. Magdalena, Sorsogon
and she is the MOTHER of the patient ZAIRA KATHRYL E. DAYMON.

This further certifies that she belongs to the indigent families in this
barangay and is in need of assistance.

This certification is issued upon request of the interested party for


MEDICAL ASSISTANCE.

Issued this ____ day of JULY 2022 in Barangay 2, Poblacion, Sta.


Magdalena, Sorsogon.

HON. FLORENDA F.
GALLON
Punong Barangay

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