OMNIBUS CERTIFICATION OF AUTHENTICITY AND VERACITY OF

DOCUMENTS
I, ANGIELYN A. BARCIAL, of legal age, Filipino, single and resident of Brgy. Buenavista
Rosario Northern Samar, after having been duly sworn to in accordance with law, hereby
depose and state that:
1. I am applying for T1 Junior High School at BUENAVISTA NATIONAL HIGH SCHOOL
Name of School
BRGY.BUENAVISTA, ROSARIO, NORTHERN SAMAR
Address of school

2. I have submitted the following documents:

a. Application Letter
b. CSC FORM No. 212(Revised 2017)
c. Photocopy of valid and updated PRC license/ ID
d. Photocopy of certification of rating
e. Photocopy of Transcript of Record (TOR)
f. Photocopy of certificate of Trainings
g. Photocopy of Contract of Service, or duly signed; Service Record
h. Checklist of Requirements and Omnibus Sworn Statement on the Certification on the
Authenticity and Veracity (CAV) of the documents submitted and Data Privacy Consent
Form pursuant to RA No. 10173 (Data Privacy Act of 2012), using the Annex C of
DepEd Order 007, s.2023, notarized by authorized official; and
i. Notarized Omnibus Certification of Authenticity and Veracity of all documents
submitted and signed by applicant;
j. Photocopy of Voter’s Certification.
3. I am executing this Certification to attest the authenticity and veracity of all documents
submitted.
4. By executing this Omnibus Certification of authenticity and Veracity of Documents, I hereby
authorize the Department of Education, Division of Northern Samar, to verify the authenticity of
the above mention documents.

IN WITNESS WHEREOF, I have hereunto affixed my signature this______day of

________, 2023 at Buenavista Rosario Northern Samar Philippines.

_______________________
Signature over printed name

SUBSCRIBED AND SWORN TO BEFORE ME., this____day of________2023 at

____________.

Doc.No._________;
Page No.________ ;
Book No._______ ;
Series of_________;
______________________
Notary Public
 OMNIBUS CERTIFICATION OF AUTHENTICITY AND VERACITY OF
DOCUMENTS
I, ANGIELYN A. BARCIAL, of legal age, Filipino, single and resident of Brgy. Buenavista
Rosario Northern Samar, after having been duly sworn to in accordance with law, hereby
depose and state that:
1. I am applying for T1 Senior High School at BUENAVISTA NATIONAL HIGH SCHOOL
Name of School
BRGY.BUENAVISTA, ROSARIO, NORTHERN SAMAR
Address of school

2. I have submitted the following documents:

a. Application Letter
b. CSC FORM No. 212(Revised 2017)
c. Photocopy of valid and updated PRC license/ ID
d. Photocopy of certification of rating
e. Photocopy of Transcript of Record (TOR)
f. Photocopy of certificate of Trainings
g. Photocopy of Contract of Service, or duly signed; Service Record
h. Checklist of Requirements and Omnibus Sworn Statement on the Certification on the
Authenticity and Veracity (CAV) of the documents submitted and Data Privacy Consent
Form pursuant to RA No. 10173 (Data Privacy Act of 2012), using the Annex C of
DepEd Order 007, s.2023, notarized by authorized official; and
i. Notarized Omnibus Certification of Authenticity and Veracity of all documents
submitted and signed by applicant;
j. Photocopy of Voter’s Certification.
3. I am executing this Certification to attest the authenticity and veracity of all documents
submitted.
4. By executing this Omnibus Certification of authenticity and Veracity of Documents, I hereby
authorize the Department of Education, Division of Northern Samar, to verify the authenticity of
the above mention documents.

IN WITNESS WHEREOF, I have hereunto affixed my signature this______day of

________, 2023 at Buenavista Rosario Northern Samar Philippines.

_______________________
Signature over printed name

SUBSCRIBED AND SWORN TO BEFORE ME., this____day of________2023 at

____________.

Doc.No._________;
Page No.________ ;
Book No._______ ;
Series of_________;
______________________
Notary Public