REPUBLIC OF THE PHILIPPINES )

PROVINCE OF NUEVA VIZCAYA )S.S.

MUNICIPALITY OF BAYOMBONG )
X………………………………………X

JOINT AFFIDAVIT OF TWO ( 2 )

DISINTERESTED PERSONS
We, ____________________________ and _________________, both legal age,
Filipino citizens and residents of ___________________, after having been sworn in accordance
with law, do hereby depose and state:

That we are currently employed at Renmar’s Specialist Hospital as Medical Records

Officer with Employee ID No. ______ and Human Resources Officer with Employee ID No.
_____ respectively, copies of our Employee ID are hereto attached and marked as Annexes “A”
and “B” respectively;

That we personally know RUTH MARIE A. LACAY, a registered Nutritionist Dietitian

with PRC Reg. No. _________________;

That she was employed as a Dietitian at Renmar’s Specialist Hospital for ___ months,
from November ____, 2019 to _____________ ___, 2020;

That we know the foregoing facts for we were co-workers at Renmar’s Specialist
Hospital;

That we are voluntarily executing this affidavit to attest to the foregoing facts and to
attest that she was indeed an employed at Renmar’s Specialist Hospital and for all legal intents
and purpose.

IN WITNESS WHEREOF, we have hereto affixed our signatures this _____ day of
______________________ at Bayombong, Nueva Vizcaya.

BIENVINIDO L. BLANCO EMILIO A. LICUPA

(Affiant) ( Affiant )
Senior Citizen I.D No. 3711-08-24 Senior Citizen I.D No. 3711-08-40

SIGNED IN THE PRESENCE OF:

1. _________________________ 2. __________________________

SUBSCRIBED AND SWORN to before me this _____ day of ______________________

at Bayombong, Nueva Vizcaya.

Doc No. ______

Page No.______
Book No. ______
Series of _______