Republic of the Philippines

Department of Education
CaragaAdministrative Region
DIVISION OF AGUSAN DEL
SUR
Government Center, Patin-ay
Prosperidad
TEACHERS SWORN
STATEMENT FOR
ATTENDING SCHOOL
(As required in Memo 51, s.
1962)
And Department Order No. 12,
s. 1962
TO WHOM IT MAY
CONCERN:
I HEREBY CERTIFY UNDER
OATH that I have been actually
enrolled in the school
or school listed in the
accompanying Transcript of
records and that I have actually
carried the
units indicated therein. As
required, the Department of
Education has been furnished
with
authentic copies of sworn
statement and its enclosure in
accordance with the provisions
of
Department Order 12, s.1962,
enclosures to Memorandum No.
51, s. 1962.
__________________________
_______
Signature Over Printed Name of
Teacher
SUBSCRIBED AND
SWORN to before me
this___________ day of
_______________ affiant
exhibiting his/her Residence
Certificate No.
__________________, issued
at ____________________
on
__________________________
_.
__________________________
_________
Signature of Person
Administering the Oath
Province of Agusan del Su
Republic of the Philippines
Department of Education
CaragaAdministrative Region
DIVISION OF AGUSAN DEL
SUR
Government Center, Patin-ay
Prosperidad
TEACHERS SWORN
STATEMENT FOR
ATTENDING SCHOOL
(As required in Memo 51, s.
1962)
And Department Order No. 12,
s. 1962
TO WHOM IT MAY
CONCERN:
I HEREBY CERTIFY UNDER
OATH that I have been actually
enrolled in the school
or school listed in the
accompanying Transcript of
records and that I have actually
carried the
units indicated therein. As
required, the Department of
Education has been furnished
with
authentic copies of sworn
statement and its enclosure in
accordance with the provisions
of
Department Order 12, s.1962,
enclosures to Memorandum No.
51, s. 1962.
__________________________
_______
Signature Over Printed Name of
Teacher
SUBSCRIBED AND
SWORN to before me
this___________ day of
_______________ affiant
exhibiting his/her Residence
Certificate No.
__________________, issued
at ____________________
on
__________________________
_.
__________________________
_________
Signature of Person
Administering the Oath
Province of Agusan del Su