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Republic of the Philippines

Quezon City
Quezon City Health Department

Order of Payment
Individual Health Certificate

The City Treasurer Bldg.


Miscellaneous Section

Sir / Madam:
Please accept payment from Mr. / Ms. Raul Pabroja Alagon the amount of ₱125.00 Computed as follows:

Name Amount

Health Certificate Fee 613-004 ₱75.00

HIV/AIDS Seminar Fee ₱50.00

Massagist Course Fee ₱0.00

VD Clearance/Smear Fee ₱0.00

Laboratory Fees  

Stool Exam ₱0.00

Sputum/Xray Exam ₱0.00

Verification ₱0.00

Health Occupancy Permit Fee 605-010 ₱0.00

Total ₱125.00

RAMONA ASUNCION DG. ABARQUEZ, MD, MPH


Authorized Personnel

Paid under O.R. #:  


Date:  

Reference No.: J082481Y

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