OMNIBUS CERTIFICATION OF AUTHENTICITY AND VERACITY OF

DOCUMENTS

I, CHRISTINE JHEN N. SAMBRANA, Filipino, of legal age, with permanent address at

__________________________________________________, after being sworn in accordance with law,
hereby depose and state that:

1. I am applying for Teacher 1 at _________________________,

Position Name of School

______________________________;
Address of School

2. I have submitted the following documents:

2.1 CSC Form 212 (revised 2017) in two copies with the latest 2x2 ID picture
2.2 Certified photocopy of PRC professional identification card
2.3 Certified photocopy of ratings obtained in the Professional Board
Examination for Teachers
2.4 Certified copy of Transcript of Records with General Weight Average
2.5 Checklist of Requirements and Omnibus Sworn Statement on the
Authenticity and Veracity of Documents and Data Privacy Consent form
(Annex C)
2.6 Certificates of relevant trainings
2.7 Comelec ID/ Voter’s Certification
2.8 NBI Clearance /PSA Marriage Certificate

3. I am executing this Certification to attest to the authenticity and veracity of all documents
submitted.

4. By executing this Omnibus Certification of Authenticity and Veracity of

Documents, I hereby authorize the Department of Education, Division of _____________, to
verify the authenticity of the abovementioned documents.

__________________________
Signature over printed name

__________________________
Date

SUBSCRIBED AND SWORN to before me in City / Municipality ________________ this _____ day of
__________, 2015, affiant exhibiting to me his/her Community Tax Certificate No. ________ issued on
______________ at ________________, Philippines.

__________________________
Notary Public