Republic of the Philippines

Province of Bohol
City of Tagbilaran

AFFIDAVIT OF UNDERTAKING

I, ERMELINDA Z. PIEZAS , of legal age and a resident of

(Name of the Adviser)
CABULIJAN TUBIGON, BOHOL , and a Deped Bohol Division
(Address)

employee and a current Adviser of ALEXIE MARIE C. RECONES , of

(Name of Student Athlete)

MATER DEI COLLEGE for and in behalf of the Division Sports Credentials
(Name of School)

Committee, do hereby agree and undertake to abide and be bound by the following:

1. Adhere and comply with the provisions of Deped Memo No. 005 Series of 2023 and its existing
rules and regulations in the application and submission of the student’s credentials for CVIRAA
2023;

2. Commit to serve and validate only legitimate student athletes who are qualified from the
Deped Memo No. 005 Series of 2023 as pre-determined from the results of the Deped Bubble
Sports and shall not use her appointment for any unlawful purpose in screening and validating
the students credentials other than those enunciated under the said memo;

3. Submit only valid and updated documentary requirements, whether for the student athletes and
their coach/es which pertain to my appointment and role as an Authorized Personnel (AP) for the
DSAC;

4. Ensure that the requirements are submitted on time;

5. To keep the original documents/ credentials and present the original copies in the event of
disputes and protest or as deemed needed by the DSAC;

6. Submit immediately a notification of any changes in the personal contact details of the student-
athletes, guardians and coaches;

7. Submit myself to any and all liabilities that may arise from any and all unlawful act/s I committed,
including documents found to be fraudulent or tampered with as submitted to DSAC;

Signed this day of , 20 in the

City/Municipality of .

Affiant
Government ID:
Issued on:
Issued at:

SUBSCRIBED and SWORN TO before me this day of , 20 , at

Affiant having exhibited to me the ID indicated above.

Doc. No.
Page No.
Book No.
Series of DSAC form 1