Revised as of February 2024

Republic of the Philippines)

City of ___________________)S.S.
OMNIBUS AFFIDAVIT
(for Public and Private Personnel)

JHANET N. JIMENEZ
I _______________________________, of legal age, single/married,
BRGY. 05, BALER, AURORA
with postal address at___________________________, after having duly
sworn in accordance with law hereby depose and state:
DEPED - AURORA
That I am presently employed with the __________________ as
TEACHER I
_______________________;

That I have been employed in DINADIAWAN NATIONAL HIGH SCHOOL

______________________________
JANUARY 4, 2021
since _____________________or 3 YEARS
for a period of _______________;

ARNIS SECONDARY GIRLS who

That I was designated as coach of _______________________,
will participate in the School Sports activities of the Department of
Education up to 20__24 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
DIPACULAO, AURORA
_______ day of _____________________20__ in ________________________,
Philippines.

JHANET N. JIMENEZ
__________________________
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)