Republic of the Philippines

City of Malaybalay S.S

Province of Bukidnon
AFFIDAVIT OF MERIT
I , _____________________________________________ of legal age, married,
with residence
and postal address at _________________________________________________,after
having been
duly sworn in accordance with the Law, depose and say:
That
I
am
________________________________

_______________________________in

That
I
have
finished
my
_______________________________________in the
year,
______________,
with
_______________________________________________

schooling
a

at

degree

the
of

That
I
have
enrolled
at
the
_______________________________________________covering
the
_______
semester
and
___________
semester
(__________),
________________________and
_____________semester (__________) thereby earning _______________units
leading to the degree
of_____________________________________________.
That
I
have
continued
my
studies
____________________________________________
Completing ________ units in the second sem (___________) and first se
(__________________)
leading
to
the
degree
___________________________________________

at

That I have earned

________________________________.

to

total

of

_______

units

leading

of

That I am executing this affidavit to attest to the truth of the

foregoing facts and
for the purpose of complying with the requirements of Department Order
No. 12, 5-1962,
an enclosure to memorandum No. 51, 5-1962;
In witness whereof, I have hereunto set my hands this ______________
Day of _____________
At Malaybalay City, Province of Bukidnon, Philippines.

______________
AFFIANT

Subscribed and sworn to before me this ________________ day of ___________,

______________ at
Malaybalay
City,
Province
of
Bukidnon,
Philippines
by_____________________________________
aboved named affiant and I hereby certify that I personally examined the
affiant and have satisfied myself that she has voluntarily executed and
understood this sworn statement.

JUTCHEL L. NAYRA, DPA

Administrative Officer V