Republic of the Philippines)

City of Cebu) S.S.

AFFIDAVIT OF SEPARATION

I, ___________, Filipino, of legal age, married and a resident of Barangay Opao,

Mandaue City, after being duly sworn, hereby depose and state under oath, that:

1. I am the President of , a company engaged in the business process outsourcing

services with principal office at, Mandaue City. As president, I take overall charge
of the operations of the company and exercise direct control and supervision
over its affairs.

2. Our company had under its employ the following persons who have been
enrolled with the governments Social Security System and assigned the
corresponding social security numbers, to wit:

3. On the following given dates, the above-listed persons were separated from
their employment with our company, and thereafter, were never again re-
employed, viz.

4. As a result of the foregoing, now ceases to be their employer.

5. In behalf of the company, I am executing this Affidavit to attest to the

truthfulness of the fact of their severance from our employment and to put on
record this truism.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have signed this Affidavit on the 18 April 2017 at Cebu City,
Philippines.

Affiant

SUBSCRIBED AND SWORN to before me on the same date and place mentioned
above by affiant whom I have identified thru her drivers license ______________ and
who, upon personal examination, has shown that she voluntarily executed and
understood this Affidavit.