REPUBLIC OF THE PHILIPPINES

CITY OF _______________

AFFIDAVIT
I, _________________________, of legal age, single/married, Filipino and a
resident of __________________________________, after being duly sworn in accordance
with the law, depose and say:

1. That I am a __________________ registered with the

________________________ on _________________ with Registration No.
______________. Machine copy of my ___________ ID is hereto attached as
ANNEX “A”;

2. That I was employed by _____________________________ as a

_________________ from ______________ up to __________________;

3. That my employment with the __________________ of

_______________________________ is supported by the Certificate of
Employment issued in my favor dated __________________ and signed by
_________________________________. Machine copy of the said Certificate of
Employment is hereto attached as ANNEX “B”;

4. That the above-mentioned Certificate was issued in my name and by

competent person/s authorized to represent the said ___________ and to issue
the same;

5. That the said certificate is genuine and a faithful reproduction of the original
document on record;

6. That I am executing this affidavit to attest the truth of the foregoing facts and
for whatever legal purpose this may serve.

IN WITNESS WHEREOF, we have hereunto set our hand this _______ day of
___________________, in the City of _____________, Philippines.

______________________________
AFFIANT

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for the City
of ____________, this _______ day of ____________ _____. Affiant personally came and
appeared with his/her Identification Card ____________________ bearing his/her
photograph and signature, known to me as the same person who personally signed the
foregoing instrument before me and avowed under penalty of law to the whole truth of
the contents of said instrument.

Doc No. _______;

Page No. _______;
Book No. _______;
Series of 20___.