Republic of the Philippines )

CITY OF SAN PEDRO S.S

Province of Laguna
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AFFIDAVIT

I, EDRALYN S. AGNES, student of Muntinlupa National High School, Filipino citizen,

with residence and postal address at Blk. 39 Lot 9 Southville 3A, Barangay San Antonio, City of
San Pedro, Laguna, after having been duly sworn to in accordance with law, do hereby depose
and say:

1. That, I was a transferee from Southville 3A National High School of City of San Pedro,
Laguna and current student of the above mentioned school;

2. That, because of my upcoming graduation fin 2020, my current school was requesting my
former school the original copy of my FORM 137;

3. That, last July 2019 I applied for the UPCAT exam. In line with the said exam, I was
required to pass all the necessary documents and one of the was the certified true copy of
my FORM 137, but I mistakenly passed the original copy;

4. That, I am owning the mistake as it was my own doing and fault;

5. I am executing this affidavit, to inform the proper authorities of the above stated facts, to
attest to the veracity of truth of the foregoing and for all legal intents and purposes this
may serve best;

IN TRUTH WHEREOF, I have hereunto set my hand this 12 th day of December, 2019 at
the City of San Pedro Laguna

EDRALYN S. AGNES
Affiant

SUBSCRIBED AND SWORN to before me this 12th day of December 2019 in San Pedro Laguna.
Affiant having exhibited to me her proof of Identity Barangay I.D with No. 2019-001989

Doc. No: ________

Page No.:________
Book No.:________
Series of 2019