REPUBLIC OF THE PHILIPPINES)

City of Roxas)SS.

AFFIDAVIT OF CONSENT

I, NINFA V. DELA TORRE, of legal age, Filipino, married and a resident of Brgy. Lucero,
Jamindan, Capiz depose and state that:

1. That I am the mother of Jedny V. Dela Torre, a 4th year college student enrolled in the
degree program of Bachelor in Secondary Education (Major in English) at Capiz State
University (Roxas City Campus).
2. That my daughter is required to enroll in FS 417 (Practice Teaching) as part of her
academic requirements.
3. That she undertakes to perform her FS 417 (Practice Teaching) this first academic
semester of 2018.
4. That she will enroll the said subject in the second academic semester, hence the
performance and compliance will come first before the enrolment of the said subject.
5. That I hereby signify my written consent, freely, willingly, and voluntary to allow my
daughter to undertake such acts, as long as her actions are allowed by the university
administration.
6. That I am executing this affidavit to attest the truth and veracity of the foregoing facts as
to my undertaking to give consent to my daughter, Jedny V. Dela Torre to support her
actions for the compliance of her academic requirements in FS 417 (Practice Teaching).

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of June, 2018
in Catalan Law Office, Inzo Arnaldo St., Roxas City, Capiz, Philippines.

NINFA V. DELA TORRE

Affiant

SUBSCRIBED AND SWORN to before me this __ day of June, 2018, by NINFA V. DELA
TORRE, who has satisfactorily proven to me her identity through her PWD ID No.
061906018-0063 that she is the same person who personally signed before me, the foregoing
Affidavit of Undertaking and acknowledged that she voluntarily executed the same.

Doc No. _____;

Page No. ____;
Book No. ___;
Series of 2018