Document Code: SDO-QF-PER-062

QUALITY FORM Revision: 00

Effectivity date: 10-16-2017

Sworn Statement for ERF Name of Office: PERSONNEL

REPUBLIC OF THE PHILIPINES

PROVINCE OF BATAAN
MUNICIPALITY OF _______________

I HEREBY CERTIFY under oath that I have been enrolled in the schools listed in the
accompanying transcript of records and that I have actually earned the units indicated therein. As
required the Bureau of Private Schools has been furnished with authentic copies of the sworn and
closure.

________________________
(Signature Over Printed Name)

SUBSCRIBE AND SWORN to before me this ___________ day of _______________, affiant

Exhibiting Residence Certificate Number ____________________ issued
at________________________ on ____________________.

PILAR C. IGNACIO
Administrative Officer V
(Signature of Person Administering
Oath)

Doc. No. ______

Page No. ______
Book No. _____
Series of ______

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