Revised as of September 26, 2019

Republic of the Philippines)

City of ___________________)S.S.

OMNIBUS AFFIDAVIT
(for Public and Private Personnel)

I ____NORHAMIN B. MAULANA_________________, of legal age,

single/married, with postal address at___________________________ ,after
having duly sworn in accordance with law hereby depose and state:

That I am presently employed with the __DEPED______ as

_Regular/Permanent Teacher_________.

That I have been employed in __MAULANA NATIONAL HIGH

SCHOOL_______ since _May 14, 2013______or for a period of _7
YEARS________;

That I was designated as coach of _SEPAK TAKRAW_______, who

will participate in the School Sports activities of the Department of
Education up to 20__ Palarong Pambansa;

That I will perform my duties and responsibilities in accordance

with DepEd Rules and Policies for the benefit of the students athletes
under my care and custody.

That all the athletes are not members of the National Team,
National Training Pool, and Development Pool of the Philippine Sports
Commission (PSC);

That all the athletes records submitted are true and correct to the
best of my personal knowledge;

Further, I authorize the personnel of Department of Education to

collect, process, retain, and dispose of my personal information in
accordance with the Data Privacy Act of 2012.

That I execute this Affidavit to attest to the authenticity and

veracity of all the documents submitted.

IN WITNESS WHEREOF, I have hereunto set my hand this _______

day of _____________________20__ in ________________________, Philippines.

S
_NORHAMIN B. MAULANA_
Affiant

SUBSCRIBED and sworn to before me in ______________, this day ____________of

month 20___, affiant executing his/her ____________ ___________, issued at
_________ on _____________.

_________________________
Notary Public

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)