SWORN STATEMENT

(Public Schools)
REPUBLIC OF THE PHILIPPINES
PROVINCE OF BULACAN
CITY OF SAN JOSE DEL MONTE

I _______________________________, of legal age, single/married, with postal

address at___________________________, after having duly sworn in accordance with law
hereby depose and state:
That I am presently employed with _______________________________ as
_______________________;
That I have been employed in ____________________________________ since
_____________________ or for a period of _______________;
That I was designated as coach of ______________________________________,
who
will participate in the lower meet up to ___________Palarong Pambansa;
That all the athletes’ records submitted are true and correct to the best of my personal
knowledge;
That all the athletes of _____________________, who will participate in the
______________________________Meet are eligible;
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

_______________________ in ________________________________, Philippines.

Affiant

SUBSCRIBED AND SWORN TO before me this ________day of

_________________, 2023 in _____________________, affiant exhibiting to me his/her
Community Tax Certificate No. ______________________, issued on
______________________ in __________________________.

______________________________________
DSAC Control Number:
SWORN - _________________ Encoded by: _____________Date: ____________