REPUBLIC OF THE PHILIPPINES )

LOPEZ, QUEZON ) S.S.

X----------------------------------------------------)

AFFIDAVIT OF LATE SUBMISSION OF GRADES

I, WALFRANDO E. ADAN, of legal age, single a resident of Barangay Bebito, Lopez,

Quezon, after having been duly sworn to in accordance with law, hereby depose and
says:

1. That, I am presently a Lecturer of the Polytechnic University of the Philippines

(PUP) at Lopez, Quezon;

2. That, during the First Semester of Academic Year 2022 - 2023, I handled a Class
with the subject CHEM 015 (CHEMISTRY FOR ENGINEERS) scheduled every
5:30PM to 8:30PM of FRIDAY and 2:00PM to 5:00PM of SATURDAY;

3. That, John Philip L. Tancinco was among my students on the aforementioned

class;

4. That during that semester, the report rating of John Philip L. Tancinco on the
aforementioned subject was not submitted on the scheduled date on the ground
that he is not included on the official class list by reason of non-payment of tuition
fees;

5. That he was only able to settle his tuition fees last February 27, 2023;

6. That I am executing this affidavit freely and voluntarily based on my personal

knowledge in order to attest the truth of the foregoing facts and circumstances.

IN WITNESS WHEREOF, I have hereunto set my hand this 28 th day of February 2023,
at Lopez, Quezon, Philippines.

WALFRANDO E. ADAN
Affiant

SUBSCRIBED AND SWORN to before me this 28th day of February 2023, at Lopez,
Quezon, Philippines. Affiant exhibited to me his ID No. _________________ issued by
Professional Regulation Commission, 2014, as his competent evidence of identity.