Revised as of September 26,

Republic of the Philippines)

City of ___________________)S.S.

OMNIBUS AFFIDAVIT
(for Public and Private Personnel)

I PETER EDRYNE G DIZON/MARRIED, with postal address at

B-49 L-10A BRGY SAN ISIDRO, STA LUCIA RESETTLEMENT
MAGALANG, PAMPANGA,after having duly sworn in accordance with
law hereby depose and state:

That I am presently employed with the DEPED, DIVISION OF

MABALACAT CITY as TEACHER -1_;

That I have been employed in MADAPDAP RESETTLEMENT

ELEMNTARY SCHOOL since _JUNE 17, 2018_or for a period of 4
YEARS;

That I was designated as coach of ATLETHICS, who will

participate in the School Sports activities of the Department of
Education up to 2023 Palarong Pambansa;

That I will perform my duties and responsibilities in accordance

with DepEd Rules and Policies for the benefit of the students athletes
under my care and custody.

That all the athletes are not members of the National Team,
National Training Pool, and Development Pool of the Philippine Sports
Commission (PSC);

That all the athletes records submitted are true and correct to
the best of my personal knowledge;

Further, I authorize the personnel of Department of Education

to collect, process, retain, and dispose of my personal information in
accordance with the Data Privacy Act of 2012.

That I execute this Affidavit to attest to the authenticity and

veracity of all the documents submitted.

IN WITNESS WHEREOF, I have hereunto set my hand this

_____day of ____________2023 in MABALACAT CITY Philippines.

PETER EDRYNE G DIZON

Affiant

SUBSCRIBED and sworn to before me in ______________, this day

____________of month 20___, affiant executing his/her ____________
___________, issued at _________ on _____________.

_________________________
Notary Public

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)