20A. RECORD OF IN-SERVICE TRAININGS, STUDY AND SCHOLARSHIP GRANTS AS SWIMMER, COACH, AND OFFICIATING OFFICIALS
Title of seminars/conference/course/training		Designation	Inclusive Dates	No. of Hours	Conducted by
(Continue on separate sheet, if necessary)
21. SPECIAL SKILLS
22. OTHER QUALIFICATIONS (Include membership in related associations, clubs, hobbies, etc.)
(Continue on separate sheet, if necessary)
22. Do you have any pending  a) administrative case   (    ) Yes    (    ) No			b) criminal case     (    ) Yes		(    ) No
If you have any, give details of the offence:
23. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or tribunal?
	(    ) Yes	(    ) No
24. Have you ever been convicted of any administrative offence?			(    ) Yes	(    ) No
If your answer is "Yes", give details of the offence.
25. I declare that the answer given above are true and correct. In this connection, I hereby authorized the Association or its authorized
representative to verify/validate the contents stated herein.
Community Tax Certificate No.
Issued at:			Signature
Issued on:
	Date Accomplished
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