REPUBLIC OF THE PHILIPPINES )

CEBU CITY ) S.S.

AFFIDAVIT

I, ________________, Filipino, of legal age, married and with residential address at

Carcar City, Cebu, after having been sworn in accordance with law, hereby depose and state
that:

1. I am an office staff of _______________, a domestic corporation

with principal office address at ____________________;

2. I have been employed by the said corporation since the beginning

of its operations in ____;

3. I am the office staff in charge of making the payroll of the

company;

4. I know ________________ because he was engaged by the

corporation as a _________________ in _____;

5. Prior to his engagement, __________________ was only a casual

worker which the corporation hired occasionally as needed whenever there was
a task that needed his services;

6. Last _________________, __________________ was

reprimanded by the corporation’s president for _______________________.
After which, he left his post and did not finish the rest of his workday;

7. On __________________, ________________ did not report for

work. Because of this, _______________, the corporation’s president, asked me
to go to ___________________ residence, which was just beside the
warehouse, to ask him why he did not report for work;

8. __________________ told me that he will no longer work for the

Corporation and asked if he could get his separation pay;

9. After __________________ received the return to work order with

notice to explain from the corporation, he stopped by the office and gave me his
reply letter wherein he reiterated his desire not to return to work anymore;

10. I am executing this affidavit to attest to the above-mentioned facts.

Affiant further sayeth none.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of

________________ at ___________________.

_______________________
Affiant

SUBSCRIBED AND SWORN to before me this _____ day of ___________________ at

____________________, affiant exhibiting to me his competent evidence of identity
________________________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017.