Revised as of September 26, 2019
Republic of the Philippines)
City of Lingayen, Pangasinan)S.S.
OMNIBUS AFFIDAVIT
(for Public and Private Personnel)
I JIAO, LUISITO C. of legal age, single/married, with
postal address at CALASIAO, PANGASINAN, after having duly
sworn in accordance with law hereby depose and state:
That I am presently employed with the DEPARTMENT OF
EDUCATION as TEACHER III;
That I have been employed in SAN MIGUEL ELEMENTARY
SCHOOL since JULY 2019_or for a period of _5 YEARS_;
That I was designated as coach of _TABLE TENNIS BOYS
ELEMENTARY, who will participate in the School Sports activities of
the Department of Education up to 20__ 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
_______ day of _____________________20__ in ________________________,
Philippines.
__________________________
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)
