(SWORN STATEMENT TO ACCOMPANY TRANSCRIPT OF RECORDS

AS
REQUIRED BY DEPARTMENT ORDER NO. 12 S. 1962)

I hereby certify under oath that I have actually enrolled in the

school or schools listed in the accompanying transcript of records and
that I have actually earned the units indicated herein. As required, the
Bureau of Private Schools has been furnished with authentic copies of
the sworn statement and its enclosure.

____________________________
Signature of
Student

SUBSCRIBED AND SWORN before me this ___________________

day
of __________________, 201____affiant exhibiting Community Tax
Certificate
No. __________________ issued at _____________________________
on
__________________________.

________________________
NOTARY
PUBLIC

Doc. No. _____________

Page No. _____________
Book No. _____________
Series of ______________

Affix Documentary
Stamp Here