Revised as of September 26,
Republic of the Philippines)
City of __________________)S.S.
OMNIBUS AFFIDAVIT
(for Public and Private Personnel)
I , of legal age, single/married, with postal address at 284
Bernardino St Nagbalon Mrilao,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 MABALACAT COMMUNITY HIGH
SCHOOL since _AUGUST 12, 2012_or for a period of 7 YEARS;
That I was designated as coach of BASKETBALL SB, who will
participate in the School Sports activities of the Department of
Education up to 2020 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
20TH day of SEPTEMBER_2019 in MABALACAT CITY Philippines.
MAUREEN J. SARMIENTO
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)
