Omnibus Certification
Omnibus Certification
DEPARTMENT OF EDUCATION
Region III
SCHOOLS DIVISION OFFICE OF NUEVA ECIJA
I, , Filipino, of legal age, with permanent address at, after being sworn in accordance with
law, hereby depose and state that:
__________________________
Signature over printed name
____________________
Date
SUBSCRIBED AND SWORN TO before me this _____ day of __________, 2019, affiant
exhibiting to me his/her Community Tax Certificate No. ________ issued on ______________ at
________________, Philippines.
____________________
Notary Public