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REPUBLIC OF THE PHILIPPINES )

LOPEZ, QUEZON ) S.S.


X----------------------------------------------------)

AFFIDAVIT OF LATE SUBMISSION OF GRADES

I, DAVE M. PERION, of legal age, single a resident of Rosario St., Barangay


Gomez, Lopez, Quezon, after having been duly sworn to in accordance with law, hereby
depose and says:

1. That, I am presently a Lecturer of the Polytechnic University of the Philippines at


Lopez, Quezon;

2. That, during the First Semester of Academic Year 2022 - 2023, I handled a Class
with the subject MATH 101 (CALCULUS I) scheduled every 9:00AM to 12:00NN
of FRIDAY;

3. That, John Philip L. Tancinco was among my students on the aforementioned


class;

4. That during that semester, the report rating of John Philip L. Tancinco on the
aforementioned subject was not submitted on the scheduled date on the ground
that he is not included on the official class list by reason of non-payment of tuition
fees;

5. That he was only able to settle his tuition fees last February 27, 2023;

6. That I am executing this affidavit freely and voluntarily based on my personal


knowledge in order to attest the truth of the foregoing facts and circumstances.

IN WITNESS WHEREOF, I have hereunto set my hand this 28 th day of February 2023,
at Lopez, Quezon, Philippines.

DAVE M. PERION
Affiant

SUBSCRIBED AND SWORN to before me this 28th day of February 2023, at Lopez,
Quezon, Philippines. Affiant exhibited to me his ID No. _________________ issued by
Professional Regulation Commission, 2014, as his competent evidence of identity.

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