Republic of the Philippines)

City of Himamaylan)S.S.

SWORN STATEMENT
I CELNIT JOY C. DY, of legal age, single/married, with postal
address at Brgy. BRGY.2, HIMAMAYLAN CITY NEGROS OCCIDENTAL ,after
having duly sworn in accordance with law hereby depose and state:

That I am presently employed with the SIX YEARS AND FOUR MONTHS
as teacher 1;

That I have been employed in HIMAMAYLAN NATIONAL HIGH SCHOOL

since AUGUST 16, 2012 or for a period of 7 YEARS AND 1 MONTHS;

That I was designated as coach of VOLLEYBALL GIRLS, who will

participate in the 2019 Division Sports Meet;

That all the athletes are not members of the National Team,
National Training Pool and Development Pool receiving monthly
stipend/allowance from the Philippine Sports Commission (PSC);

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

That all the athletes of TABLE TENNIS GIRLS, who will

participate in the 2019 Division Sports Meet are eligible;

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 _____________________20__ in ________________________,
Philippines.

__________________
Affiant

SUBSCRIBED AND SWORN TO before me this ________day of

_________________, 20__ in _____________________, affiant exhibiting
to me his/her Government issued ID/SSS/PRC/Philhealth, etc.
______________________.

_________________________
Schools Division Superintendent/
Administrative Officer
Republic of the Philippines)
City of Himamaylan)S.S.

FOR PALARONG PAMBANSA ONLY

 SWORN STATEMENT
I MARY ANN A. SALOPISA, of legal age, single/married, with
postal address at Brgy. SU-AY, HIMAMAYLAN CITY NEGROS
OCCIDENTAL ,after having duly sworn in accordance with law hereby
depose and state:

That I am presently employed with the __________________ as

_______________________;

That I have been employed in HIMAMAYLAN NATIONAL HIGH SCHOOL

since JULY 13, 2017 or for a period of 1 year and 6 months;

That I was designated as chaperon of FUTSAL, who will

participate in the 2017 City Sports Meet;

That all the athletes are not members of the National Team,
National Training Pool and Development Pool receiving monthly
stipend/allowance from the Philippine Sports Commission (PSC);

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

That all the athletes of FUTSAL, who will participate in the

2017 City Sports Meet are eligible;

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 _____________________20__ in ________________________,
Philippines.

__________________
Affiant

SUBSCRIBED AND SWORN TO before me this ________day of

_________________, 20__ in _____________________, affiant exhibiting
to me his/her Government issued ID/SSS/PRC/Philhealth, etc.
______________________.

_________________________
Schools Division Superintendent/
Administrative Officer

FOR PALARONG PAMBANSA ONLY