Republic of the Philippines

Department of Education
Region VIII (Eastern Visayas)
DIVISION OF NORTHERN SAMAR
Mabini St., Brgy. Acacia, Catarman, N. Samar, 6400, Philippines
Telefax: (055) 500 9801

March 18, 2019

MS. NELIA B. LASTIMOSA

Branch Manager
Government Service Insurance System
Catbalogan Branch Office

REQUEST FOR INSURANCE COVERAGE OF NORTHERN SAMAR

ATHLETES
Ms. Lastimosa:

Greetings!

The undersigned, the Medical Officer of the Department of Education, Division of

Northern Samar, Catarman, Northern Samar, hereby writes this letter for the purpose of applying
for the health insurance coverage of all qualified athletes of Northern Samar Division for the
Eastern Visayas Regional Athletic Association (EVRAA) Meet 2019.

The undersigned, hereby further request that the insurance coverage to commence
from the training of the athletes, which will start on March 18, 2019 until April 1, 2019.

In of the foregoing premise, the undersigned would like to appeal for the coverage
of all the qualified athletes for EVRAA 2019 Meet.

Attach hereto is the official list of athletes qualified to play in the EVRAA 2019
Meet.

Thank you!

WARREN L. OTADOY, MD, FPAMS

Medical Officer IV
DepEd Division of Northern Samar

Copy furnished:

Northern Samar Provincial Government

“Soar High, Northern Samar Division!”

 Republic of the Philippines
Department of Education
Region VIII (Eastern Visayas)
DIVISION OF NORTHERN SAMAR
Mabini St., Brgy. Acacia, Catarman, N. Samar, 6400, Philippines
Telefax: (055) 500 9801

INDORSEMENT
March 18, 2019

Respectfully forwarded to MS. NELIA B. LASTIMOSA, Branch Manager,

Government Service Insurance System, Catbalogan Branch Office, the herein letter of request
from WARREN L. OTADOY, MD, FPAMS, requesting for the insurance coverage of all the
athlestes of Northern Samar for the Eastern Visayas Regional Athletic Association (EVRAA) Meet
2019, for information and appropriate approval.

Moreover, the funds that will be used for the payment of the insurance premium
will be taken from the Health Insurance Budget as approved by the Local Sports Board of the
Province of Northern Samar.

CARMELA R, TAMAYO, Ed.D., CESO VI

Schools Division Superintendent

“Soar High, Northern Samar Division!”