updated-Omnibus-Affidavit

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Revised as of April 2023

Republic of the Philippines)


City of ___________________)S.S.

OMNIBUS AFFIDAVIT
(for Public and Private Personnel)

ERIKA LOURINE KATE A. CERVANTES of legal age, single/married,


I _______________________________,
with postal address at___________________________
3B Rosario St. Bgy. Rizal Lopez, Quezon,after having duly
sworn in accordance with law hereby depose and state:
Department of Education
That I am presently employed with the __________________ as
Teacher II
_______________________;

Unisan Integrated High School


That I have been employed in ______________________________
June 19, 20217
since _____________________or for a period of7 _______________;
years and 6 months

That I was designated as coach of _______________________,


Billiards Secondary Boys who
will participate in the School Sports activities of the Department of
Education up to 20__ 25 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.

ERIKA__________________________
LOURINE KATE A. CERVANTES
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)

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