Republic of the Philippines)

City of ___________________)S.S.

SWORN STATEMENT
I, ______________________________, of legal age and with residence and post
address at _____________________________________________________________,
under oath declare:

1. That I am designated coach for ___________________________________

in the upcoming Sports Competition to be held on _________________
(Regional) and ______________________________(National);

2. That I have submitted credentials or documents pertaining to the

qualifications of my athletes to the Department of Education;

3. That said credentials or documents are valid, authentic and correct;

4. That I am executing this sworn statement to attest to the validity and

authenticity of the documents submitted;

AFFIANT FURTHER SAYETH NAUGHT

In witness thereof, I have hereto affix my signature this ______________________

__________________________ at _______________________________ Philippines.

__________________
Affiant

SUBSCRIBED AND SWORN TO before me this _______day of ______________,

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

_________________________________
Administrative Officer