OMNIBUS CERTIFICATION OF AUTHENTICITY AND VERACITY OF DOCUMENTS

I, Mary Flor B. Galvez, Filipino of legal age, with permanent address at Calaya, Nueva
Valencia, Guimaras, after being sworn in accordance with law, hereby depose and state that:

1. In connection with my appointment as Administrative Assistant I at Department of

Education, Regional Office VI, Duran Street, Iloilo City.

2. I have submitted the following documents:

- CS Form No. 212 (Personal Data Sheet)
- CS Form No. 211 (Medical Certificate) & Medical Test Results
- CAV (Certification, Authentication & Verification of Transcript of Records &
Diploma)
- Authenticated copy of the Certificate of Live Birth by the Philippine Statistics
Authority (PSA)
- Authenticated copy of the Certificate of Eligibility
- National Bureau of Investigation (NBI) Clearance

3. By executing the OMNIBUS CERTIFICATION AND VERACITY OF DOCUMENTS, I

hereby authorize the Department of Education, Regional Office VI to verify the
authenticity of the above mentioned documents.

_____________________________________
Printed Name and Signature of Applicant

SUBSCRIBED AND SWORN to before me this _________day of __________________,

201___, affiant exhibiting to me her Community Tax No. _____________________ issued on
_____________________ at _______________________, Philippines.

_______________________
Notary Public

Doc No. ___________

Page No. __________
Book No. __________