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Omnibus Certification of Authenticity

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Republic of the Philippines

DEPARTMENT OF EDUCATION
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN
Alvear St. Lingayen, Pangasinan
Tel. No./Fax No (075) 522-2202 (OSDS); (075) 632-838(ASDS)
E-mail: pangasinan1@deped.gov.ph; officeofthesdspangasinan@gmail.com.

OMNIBUS CERTIFICATION OF AUTHENTICITY


AND VERACITY OF DOCUMENTS

I, IRENE C. BUSTAMANTE, Filipino, of legal age, with permanent address of Barangay San
Pascual Burgos, Pangasinan. After being sworn in accordance with the law, hereby dispose
and state that:
1. I am the owner of the following documents submitted in the school Screening Committee
 Application letter duly signed by the applicant and which shall include the following:
 CSC Form 212, Revised 2017 (Personal Data Sheet) in two copies with the latest 2x2 ID
picture.
 Certified photocopy of PRC Certificate of Registration/ License.
 Certified photocopy of ratings obtained in the Licensure Examination for
Teachers/Professional Board Examination for Teachers.
 Certified copies of transcript of records for baccalaureate course with a certification from the
school graduated indicating the General Weighted Average (GWA).
 Certification of Masteral
 Certified copies of Service Record and Certificate of Employment.
 Certificates of specialized training, if any.
 Certification of EPT-Result
 Certified copy of the voters ID
 NBI Clearance (CERTIFICATION)
 Other Pertinent Papers necessary to support the submitted documents.
 Omnibus certification of authenticity and veracity of all documents submitted.
2. I am executing this Certification to attest to the Authenticity and Veracity of documents, I
hereby authorized the Department of Education, Schools Division Office 1 Pangasinan
Lingayen Pangasinan.
I through the School Principal, to verify the authenticity of the over mentioned documents.

IRENE C. BUSTAMANTE
Signature over Printed Name

SUBSCRIBED AND SWORN TO before me this ____ day of January, 2023, affiant exhibiting
to me his/her Community Tax Certificate No. _____________ issued on ____ day of January,
2023 in Dasol, Pangasinan.

Doc. No. _____


Page No. _____
Book No. _____
Series of _____
_____________________________________
Notary Public

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