REPUBLIC OF THE PHILIPPINES )

)S.S.

SWORN AFFIDAVIT

I, ____, of legal age, with office address at _____, after having been sworn
in accordance with law do hereby depose and state that:

1. I am currently employed as _____ for _____.

2. As a ______________, my duties and responsibilities include:

______________

3. In _____, _______ went to our office to apply as a domestic

helper/household service worker in the _____________. I asked her to fill
up the required details in the Candidate Interview Form.

4. After she submitted her Candidate Interview Form, I interviewed her and
asked questions regarding her personal circumstances including her
date of birth and age.

5. ______ told me that she was born on _______ and she was ______ years
old. In fact, she presented me her passport and National Bureau of
Investigation clearance indicating her date of birth.

6. Based on the records that she presented to me which appeared to be

valid and existing, I recommended her employment for the foreign
employer. The application has been approved and I prepared for the
necessary requirements that she needed to comply with in order to work
in _______.

7. On ______, I was in the office when I received a phone call from _______,
informing me that _____ flight was put on hold because the immigration
officers discovered that she was just a minor and not allowed to be
deployed for work.

8. I do not know that _____ was underage because she was the one who
provided me her passport indicating her date of birth which was _____.
She also presented her National Bureau of Investigation clearance when
she applied in our agency.

9. I do not know about her misleading statements because the documents

she presented showing her date of birth appeared to be legitimate and
accurate, when in truth and in fact, it was not.

10. I do not know that she concealed her true age because the interview we
conducted turned out smoothly.

11. I attest to the truth and veracity of the foregoing statements for all legal
intents and purpose it may serve.

AFFIANT FURTHER SAYETH NAUGHT.

 IN WITNESS WHEREOF, I have hereunto affixed my signature this
___________________ in the City of Manila.

AFFIANT

SUBSCRIBED AND SWORN TO before me this _________________ in the

______________ by affiant who is personally known to me and to me known to
be the same person who executed the foregoing instrument and acknowledged
to me that the same is her free and voluntary act and deed.

WITNESS MY HAND AND SEAL, on the date and place first above written.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 2020.