Republic of the Philippines
Department of Education
CARAGA
DIVISION OF AGUSAN DEL SUR
Government Center, Patin-ay Prosperidad
TEACHERS SWORN STATEMENT FOR ATTENDING SCHOOL
(As required in Memo 12, s. 1962)
And Department Order No. 51,s. 1962
TO WHOM IT MAY CONCERN:
I HEREBY CERTIFY UNDER OATH that I have been actually enrolled in
the school or school listed in the accompanying Transcript of Record and that I have actually
earned the units indicated therein. As required the Bureau of Private Schools has been
furnished with an authentic copy of the sworn statement and its closure.
___________________________________
Signature
SUBSCRIBED AND SWORN to before may this ____ day of ______________affidavit
exhibiting his/her residence certificate No. ________________________ issued
at______________on______________________.
___________________________________
Signature of Person Administering the Oath
Province of Agusan del Sur