Republic of the Philippines)

City of ________________)

AFFIDAVIT

I MARY ANN M . MUGAS, of legal age, FILIPINO, with postal address at

KINAMAYAN, STO. STO. TOMAS DAVAO DEL NORTE after having duly sworn in
accordance with law hereby depose and state:

That I am presently employed in Maryknoll School of Sto. Tomas Inc. as

Secondary Teacher ;

That I am presently employed in Maryknoll School of Sto. Tomas since

June 1, 2019 or for a period of 2 Months;

That I was designated as coach of the CHESS; Secondary Division who will
participate in the 2019 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 Maryknoll School of Sto. Tomas,Sto. Tomas Davao del
Norte who will participate in the 2019 Palarong Pambansa are eligible to play;

That I execute this Affidavit to attest to the authenticity and veracity of all the
documents submitted.

______________________, __________________

_MARY ANN M. MUGAS, LPT

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 _________

FOR PALARONG PAMBANSA ONLY