Republic of the Philippines

Department of education
Region V
_____________________________________________

SWORN STATEMENT

TO WHOM IT MAY CONCERN:

I hereby certify under oath that I have actually enrolled in the school/schools listed
in the accompanying transcript of records and that I have actually earned the units
indicated therein. As required by the CHED, has been furnished with authentic copies of
the sworn statement and its enclosure.

___________________
Signature

SUBSCRIBE AND SWORN to before me this __________________________________,

affiant exhibiting to me his Community Tax Certificate No. ______________issued at
___________________________________-.

________________________________
Notary Public

Doc. No. _______________ PTR NO. ___________________

Page No. _______________ On _______________________
Book No. ______________ Until _______________________