Department of Education Deped Region Viii-Eastern Visayas Schools Division Office of Samar
Department of Education Deped Region Viii-Eastern Visayas Schools Division Office of Samar
Department of Education
DepEd Region VIII-Eastern Visayas
SCHOOLS DIVISION OFFICE OF SAMAR
Office of the Schools Division Superintendent
Enclosure 2 Division Memorandum No. 194, s. 2021
I, of legal age
(Name of Affiant) (Civil Status)
, and residing at
(Nationality) (Address of Affiant)
After having been duly sworn in accordance with law, do hereby depose and
state that:
Affiant
Doc. No _________
Book No. ________
Page No. ________
Series of ________
Republic of the Philippines
Department of Education
DepEd Region VIII-Eastern Visayas
SCHOOLS DIVISION OFFICE OF SAMAR
Office of the Schools Division Superintendent
Enclosure 2 Division Memorandum No. 194, s. 2021
PRE-SCREENING CERTIFICATION
(School Selection Committee)
Member Member
Member Member
School Head/Chairman