REPUBLIC OF THE PHILIPPINES

IN THE _________ ) S.S.

AFFIDAVIT

I, ____________________, Filipino, of legal age, and a

resident of ___________________________________, after having
sworn to in accordance with law, hereby depose and state THAT:

1. I attended Electro-mechanics Technology, second year

student in Center for Industrial Technology and
Enterprise;

2. I entered Center for Industrial Technology and Enterprise

since 2013 to 2015;

3. I was not able to get a Transcript of Record from the

said institution because until now, I still have a
pending balance for my unpaid tuition fees;

4. This Affidavit is being executed to attest to the truth

of the foregoing statements and for whatever legal
purposes this may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this

______ day of ________________ at the City of
_____________________.

Affiant
ID No.:

SUBSCRIBED AND SWORN to before me this this ____ day of

____________, in the ____________, affiant sufficiently proved to
me his identity by exhibiting his ID, as shown above, as proof of
his identity.

Doc. No:____;
Page No:____;
Book No:____;
Series of 2020.