Official's General Information for Bicol Regional Meet 2019

Official's General Information
ATHELITIC MEET BICOL REGIONAL MEET 2019 UP TO PALARONG PAMBAN

VENUE CAMARINES SUR
DATE February 1, 2019
TRAINOR'S INFORMATION
CHESS OFFICIAL : DOMINGO F. COMBATE JR.
SCHOOL : UNION ELEMENTARY SCHOOL
POSITION TEACHER I
AGE 45
GENDER MALE
DATE OF BIRTH September 27, 1973
DATE OF ORIGINAL APPOINTMENT 28-Oct-11
EVENT CHESS
School Head/Admin. Officer ALLENE B. BALUYOT
1/10/1994 8/1/2017
282
ral Information
UP TO PALARONG PAMBANSA
NFORMATION
Republic of the Philippines
Department of Education
Region V
DIVISION OF CAMARINES SUR
CERTIFICATE OF EMPLOYMENT
(for DepEd Personnel)
Date
To Whom It May Concern:
This is to certify that Mr./Ms. DOMINGO F. COMBATE JR.
presently employed in UNION ELEMENTARY SCHOOL as TEACHER I , since
October 28, 2011 or for a period of 7 years
This certification is issued upon the request of Mr./Mrs. DOMINGO F. COMBATE JR.
to coach in BICOL REGIONAL MEET 2019 UP TO PALARONG PAMBANSA
at .
ALLENE B. BALUYOT
School Head/ Administrative Officer
FOR PALARONG PAMBANSA ONLY

(for DepEd Personnel)
(for Private School)
is
ATE JR.
School Administrator/Official
School Head/ Administrative Officer
Region V
San Jose Pili, Camarines Sur
CERTIFICATION
This is to certifiy that DOMINGO F. COMBATE JR. completed the

24 hours sports training during the Division Accreditation for Coaches
on August 17-19, 2018 at San Jose, Pili Camarines Sur and Regional Seminar Training
on Coaching in Various Sports Disciplines on Chess at Pili, Camarines Sur
Issued this 12th day of December at Camarines Sur, Philippines.
MELVIN S. MENESES
CHIEF, SGOD

Region V
CERTIFICATION
This is to certifiy that DOMINGO F. COMBATE JR. served

for at least 7 year as coach/chaperone/trainer in CHESS
Issued this 12th day of December 2018 at San Jose Pili, Camarinesw Sur, Philippines.
MELVIN S. MENESES
Division School Sports Officer

Region V
CERTIFICATION
This is to certifiy that DOMINGO F. COMBATE JR. participated as

coach in the lower meets.
Issued this 12th day of December 2018 at Pili, Camarines Sur, Philippines.
MELVIN S. MENESES

Region V
CERTIFICATE OF MEMBERSHIP
This is to certifiy that DOMINGO F. COMBATE JR. is an active

member of CENTRALIZED TECHNICAL CHESS OFFICIALS This
certificate also serves as recognition of his/her commitement to the development of
CHESS in the Division of Camarines Sur Province.
MELVIN S. MENESES

Region V
CERTIFICATE OF ACCREDITATION
This is to certifiy that DOMINGO F. COMBATE JR. is duly

accredited coach in CHESS and passed the Division Accreditation
for coaches on August 17-19, 2018 at San Jose, Pili Camarines Sur.
MELVIN S. MENESES

Region V
MEDICAL CERTIFICATE
October 2, 2019
(Date)
To Whom It May Concern:
This is to certify that I have personally examined DOMINGO F. COMBATE JR.

Name
age 46 sex MALE born on September 27, 1973 and have found that he/she is
physically fit, during the time of examination, to join and compete in the Lower Meets and
Palarong Pambansa.
Event: CHESS
Physical Examination
Date examined:
Height: Weight: Blood Pressure:

Pulse, Resting: Respiratory Rate:
Other Remarks:
Physician/Medical Officer
(Signature over printed name)
License No. :
PTR.:
Date:

City of ______________________)S.S.
SWORN STATEMENT
I DOMINGO F. COMBATE JR. , 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 UNION ELEMENTARY SCHOOL as

TEACHER I ;
That I have been employed in DEPED DIVISION OF CAMARINES SUR

since October 28, 2011 or for a period of 7 years ;
That I was designated as coach of CHESS , who will participate in the

BICOL REGIONAL MEET 2019 UP TO PALARONG PAMBANSA
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 records submitted are true and correct to the best of my personal knowledge;
That all the athletes of CHESS , who will participate in the

BICOL REGIONAL MEET 2019 UP TO PALARONG PAMBANSA are eligible;
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

2019 in Masbate City, Philippines.
DOMINGO F. COMBATE JR.

Affiant
SUBSCRIBED AND SWORN TO before me this day of , 2019

in Camarines Sur, Philippines, affiant exhibiting to me his/her Government issued ID/SSS/PRC/Philhealth, etc.
.
Administrative Officer V

City of ______________________)S.S.
AFFIDAVIT
I DOMINGO F. COMBATE JR. , 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 UNION ELEMENTARY SCHOOL as

TEACHER I ;
That I have been employed in UNION ELEMENTARY SCHOOL

since October 28, 2011 or for a period of 7 years ;
That I was designated as coach of CHESS , who will participate in the

2019 Palarong Pambansa.
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 records submitted are true and correct to the best of my personal knowledge;
That all the athletes of CHESS , who will participate in the 2019 Palarong
Pambansa are eligible;
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

2019 in Masbate Ciy, Philippines.
DOMINGO F. COMBATE JR.

Affiant
SUBSCRIBED AND SWORN TO before me this day of , 2019

in Camarines Sur, Philippines, affiant executing his/her Community Tax Certificate No.
issued at . on .
Notary Public

Region V
COMMITMENT TO NURTURE THE ATHLETES

(for Chaperons)
I 0 of legal age, single/married with

postal address at 0
That I am presently employed in 0

as 0;
That I hae been employed in 0 since

________________________ or for a period of ________________;
That I was designated as CHAPERON of 0 who will

participate in the 2019 PALARONG PAMBANSA on ______________________ to be held at
__________________________________, do hereby commit myself to foster the welfare of
athletes under my care and take the responsibility of watching their wellbeing in the du-
ration of PALARONG PAMBANSA 2019;
That I will not interfere in the coaching of our team or acting as coach of the
athletes, as it is not my responsibility to do so.
0
Signature over Printed Name of the Chaperon
____________________________
Signature over Printed Name of Coach
SUEÑO S. LUZADA JR.

SGOD Chief

Official's General Information for Bicol Regional Meet 2019

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Official's General Information

ATHELITIC MEET BICOL REGIONAL MEET 2019 UP TO PALARONG PAMBAN

To Whom It May Concern:

This is to certify that Mr./Ms. DOMINGO F. COMBATE JR.

presently employed in UNION ELEMENTARY SCHOOL as TEACHER I , since

October 28, 2011 or for a period of 7 years

to coach in BICOL REGIONAL MEET 2019 UP TO PALARONG PAMBANSA

FOR PALARONG PAMBANSA ONLY

(for Private School)

This is to certifiy that DOMINGO F. COMBATE JR. completed the

Issued this 12th day of December at Camarines Sur, Philippines.

FOR PALARONG PAMBANSA ONLY

This is to certifiy that DOMINGO F. COMBATE JR. served

FOR PALARONG PAMBANSA ONLY

This is to certifiy that DOMINGO F. COMBATE JR. participated as

FOR PALARONG PAMBANSA ONLY

This is to certifiy that DOMINGO F. COMBATE JR. is an active

FOR PALARONG PAMBANSA ONLY

This is to certifiy that DOMINGO F. COMBATE JR. is duly

FOR PALARONG PAMBANSA ONLY

To Whom It May Concern:

This is to certify that I have personally examined DOMINGO F. COMBATE JR.

Height: Weight: Blood Pressure:

FOR PALARONG PAMBANSA ONLY

I DOMINGO F. COMBATE JR. , of legal age, single/married, with postal address at

That I am presently employed with the UNION ELEMENTARY SCHOOL as

That I have been employed in DEPED DIVISION OF CAMARINES SUR

That I was designated as coach of CHESS , who will participate in the

That all the athletes of CHESS , who will participate in the

IN WITNESS WHEREOF, I have hereunto set my hand this day of

DOMINGO F. COMBATE JR.

SUBSCRIBED AND SWORN TO before me this day of , 2019

FOR PALARONG PAMBANSA ONLY

I DOMINGO F. COMBATE JR. , of legal age, single/married, with postal address at

That I am presently employed with the UNION ELEMENTARY SCHOOL as

That I have been employed in UNION ELEMENTARY SCHOOL

That I was designated as coach of CHESS , who will participate in the

IN WITNESS WHEREOF, I have hereunto set my hand this day of

DOMINGO F. COMBATE JR.

SUBSCRIBED AND SWORN TO before me this day of , 2019

FOR PALARONG PAMBANSA ONLY

COMMITMENT TO NURTURE THE ATHLETES

I 0 of legal age, single/married with

That I am presently employed in 0

That I hae been employed in 0 since

That I was designated as CHAPERON of 0 who will

SUEÑO S. LUZADA JR.

FOR PALARONG PAMBANSA ONLY

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