Republic of the Philippines

City of Malaybalay S.S

Province of Bukidnon

AFFIDAVIT OF MERIT

I , _____________________________________________ of legal age, married, with residence

and postal address at _________________________________________________,after having been
duly sworn in accordance with the Law, depose and say:

That I am a _______________________________in ________________________________

That I have finished my schooling at the _______________________________________in the

year, ______________, with a degree of _______________________________________________

That I have enrolled at the _______________________________________________covering

the _______ semester and ___________ semester (__________), ________________________and
_____________semester (__________) thereby earning _______________units leading to the degree
of_____________________________________________.

That I have continued my studies at ____________________________________________

Completing ________ units in the second sem (___________) and first se
(__________________) leading to the degree of ___________________________________________

That I have earned a total of _______ units leading to ________________________________.

That I am executing this affidavit to attest to the truth of the foregoing facts and
for the purpose of complying with the requirements of Department Order No. 12, 5-1962,
an enclosure to memorandum No. 51, 5-1962;

In witness whereof, I have hereunto set my hands this ______________ Day of _____________
At Malaybalay City, Province of Bukidnon, Philippines.

______________
AFFIANT

Subscribed and sworn to before me this ________________ day of ___________, ______________ at

Malaybalay City, Province of Bukidnon, Philippines by_____________________________________
aboved named affiant and I hereby certify that I personally examined the affiant and have satisfied
myself that she has voluntarily executed and understood this sworn statement.

JUTCHEL L. NAYRA, DPA

Administrative Officer V