Republic of the Philippines)

City of ________________)

AF F I D AV I T
I ______MARIBEL P. SIOSAN________, of legal age, ____MARRIED________, with postal
address at_TABUCAN MANDURRIAO ILOILO CITY____ after having duly sworn in accordance
with law hereby depose and state:
That I am presently employed in FELICIANA JAVA KELLY ELEMENTARY SCHOOL_as
_Teacher I_.
That I am presently employed in FELICIANA JAVA KELLY ELEMENTARY SCHOOLl
since _2009__ or for a period of _7 YEARS_;
That I was designated as coach of the _______BASEBALL___________;
_____ELEMENTARY____ who will participate in the 20___ Palarong Pambansa.
That all the athletes records submitted are true and correct to the best of my personal
knowledge;
That all the athletes are not members of the National Team, National Training Pool and
Development Pool receiving monthly stipend/allowance from the Philippine Sports Commission
(PSC);
That all the athletes of _____________________________________, _BASEBALL__
__ELEMENTARY_, who will participate in the 20___ Palarong Pambansa are eligible to play;
That I execute this Affidavit to attest to the authenticity and veracity of all the documents
submitted.
______________________, __________________
_MARIBEL P. SIOSAN_
Affiant

SUBSCRIBED and sworn to before me in _________________, this day

_______________of month 20___, affiant executing his/her Community Tax Certificate No.
______________, issued at _________ on ___________.
_______________________
Notary Public
Doc. No. _________
Page No.__________
Book No._________
Series of _________