TEACHER’S SWORN STATEMENT OF ATTENDING SCHOOL

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.

Signature of Student

SUBSCRIBED AND SWORN before me this ______________day of ________,

20 _____ affiant exhibiting Community Tax Certificate No. _______________
issued at ________________________ on _______________________.

NOTARY PUBLIC

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