REPUBLIC OF THE PHILIPPINES)

PROVINCE OF OCCIDENTAL MINDORO)

CITY/MUNICIPALITY OF SABLAYAN) S.S.

Omnibus Certification of Authenticity and Veracity of

Documents

KNOW ALL MEN BY THESE PRESENTS:

I, (Complete Name), (married/single) Filipino, of legal age, with permanent and

postal address at (Complete Address), after being sworn in accordance with
law, hereby depose and state that:

1. I am applying for (Position) at (School), (Address of School);

2. I have submitted the following documents:

2.1 Transcript of Records

2.2 PRC license ID
2.3 PRC Verification
2.4 NBI Clearance
2.5 CSC form 211 (Medical Certificate)
2.6 NSO Birth Certificate
2.7 Statement of Assets, Liabilities and Networth (SALN)
2.8 BIR Form 1902 or 2305
2.9 Marriage Contract (if applicable)

3. I am executing this Certification to attest to the authenticity and veracity of

all documents submitted.

4. By executing this Omnibus Certification of Authenticity and Veracity of

Documents, I hereby authorize the Department of Education, Division of
Occidental Mindoro, through the School Principal, to verify the authenticity of
the abovementioned documents.

_______________________________
(Signature over printed name)

____________________
(Date)