REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT

NATIONAL POLICE COMMISSION
PHILIPPINE NATIONAL POLICE
POLICE REGIONAL OFFICE
ZAMBOANGA DEL NORTE PROVINCIAL OFFICE
DIPOLOG CITY NATIONAL POLICE
DIPOLOG,ZAMBOANGA DEL NORTE

January 3, 2012

THE CHIEF OF HOSPITAL

ZANORTE MEDICAL CENTER
SICAYAB DIPOLOG CITY
ZAMBOANGA DEL NORTE

SIR:

The undersigned respectfully requesting your good office to please furnish a

copy of the Medical examination result / medical certificate to one Edison Peela, 56
years old, Male, Married and a resident of Brgy. Biasong, Dipolog City who was inv-
olved in vehicular accident transpired on or about 3:30pm of January 3, 2012 at Brgy
Biasong, Dipolog City,ZN
Your usual cooperation in this regard is highly appreciated.

Very truly yours,

P03 STEPHEN P. DUMALAGAN

CHIEF OF POLICE