Revised as of September 26,

2019
Republic of the Philippines)
City of ___________________)S.S.

OMNIBUS AFFIDAVIT
(for Public and Private Personnel)

I DIANA ROSE R. ACUPEADO, of legal age, single/married,

with postal address at PUROK 3, BRGY. BAYORBOR
MATAASNAKAHOY, BATANGAS, after having duly sworn in
accordance with law hereby depose and state:

That I am presently employed with the SAN SEBASTIAN

ELEMENTARY SCHOOL as TEACHER I;

That I have been employed in SAN SEBASTIAN ELEMENTARY

SCHOOL since 2022 or for a period of 1 YEAR;

That I was designated as assistant coach of ATHLETICS-

ELEMENTARY, who will participate in the School Sports activities of
the Department of Education up to 2024 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 JANUARY 2024 in MATAASNAKAHOY,
BATANGAS, Philippines.

__________________________
Affiant

SUBSCRIBED and sworn to before me in ______________, this day

____________of month 20___, affiant executing his/her ____________
___________, issued at _________ on _____________.

_________________________
Notary Public
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)
FOR SCHOOL SPORTS (Lower Meet up to Palarong Pambansa)