Republic of the Philippines. .

}
City of Tagum. . . . . . . . . . . . .}S.s.
Province of Davao del Norte..}
x- - - - - - - - - - - - - - - - - - -----x

AFFIDAVIT

I, ________________________ , 28 years old, Filipino, and a resident of

____________________________, after having been duly sworn to in accordance with law
hereby depose and state, THAT:

1. I am the same and identical person who caused the preparation of this affidavit
having the right and capacity to do so;

2. I graduated from _________________________, Tagum Foundation Incorporated

sometime on March 2012 in Bachelor of Science in Nursing (BSN);

3. However, I failed to submit my EXHIBIT FORMS to my school because of my

work;

4. It was last July 12, 2017 that I submitted the above mentioned Exhibit forms to
my school;

5. I am executing this affidavit to attest to the truth of the foregoing facts and for
whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto set my hand this 12 th day of July, 2017 at Tagum
City, Davao del Norte, Philippines.

______________________
Affiant
_______________________

SUBSCRIBED AND SWORN to before me this 12th day of July, 2017 at Tagum City,
Philippines.