Revised as of September 26,

2019
Republic of the Philippines)
City of Camarines Sur)S.S.

OMNIBUS AFFIDAVIT
(for Public and Private Personnel)

I NIÑO E. BELANO, of legal age, single/married, with postal

address at ZONE 3, MATAOROC, MINALABAC, CAMARINES
SUR ,after having duly sworn in accordance with law hereby depose
and state:

That I am presently employed with the DepEd______ as

___Teacher_1_________;

That I have been employed in PULANG DAGA HIGH SCHOOL

since __AUGUST 27, 2015____or for a period of __8 YEARS_____;

That I was designated as coach of ATHLETICS, who will

participate in the School Sports activities of the Department of
Education up to 2023 Palarong Pambansa;

That I will perform my duties and responsibilities in accordance

with DepEd Rules and Policies for the benefit of the students athletes
under my care and custody.

That all the athletes are not members of the National Team,
National Training Pool, and Development Pool of the Philippine Sports
Commission (PSC);

That all the athletes records submitted are true and correct to
the best of my personal knowledge;

Further, I authorize the personnel of Department of Education

to collect, process, retain, and dispose of my personal information in
accordance with the Data Privacy Act of 2012.

That I execute this Affidavit to attest to the authenticity and

veracity of all the documents submitted.

IN WITNESS WHEREOF, I have hereunto set my hand this

_______ day of _________________2023 in the City of CAMARINES SUR,
Philippines.

__________________________
Affiant

SUBSCRIBED and sworn to before me in the—______________, this ____ day of

____________ 2023, affiant executing his/her ____________ ___________, issued at _________
on _____________.

_________________________
Notary Public

FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)