Republika ng Pilipinas )

Probinsiya ng Cavite )
Munisipalidad ng Silang) S.S

SINUMPAANG SALAYSAY

Ako, Cdt ________________________, _____ taong gulang, aktibong kaanib

ng BSPS Class ___________, miyembro ng Kumpanyang ____________ at
kasalukuyang naninirahan sa loob ng Philippine National Police Academy, Silang,
Cavite, matapos mabatid ang aking karapatan ayon sa umiiral na Saligang Batas ng
Pilipinas ay Malaya at kusang loob na nagsasalaysay ng mga sumusunod:

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Upang patunayan na ang lahat ng nakasaad dito ay pawing katotohanan

lamang, at walang sinuman ang siyang nanakot o namilit sa akin upang magsagawa
ng kagaya nito, ako po ay lumagda sa ibabaw ng aking pangalan ngayong ika- ___
ng __________ 2022 dito sa PNPA, Silang Cavite.

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Nagsasalaysay

CERTIFICATION

SUBSCRIBED AND SWORN to before me this ____ day of _________ 2022

at _______________________, Silang, Cavite.

______________________________
Administering Officer