Republic of the Philippines)

Makati City, Metro Manila ) S.S.

AFFIDAVIT

I, DRA. MARIA ZENAIDA VENTURA, of legal age, married, Filipino citizen, with residence
address at ____________________, under oath, depose and state:

(1) That I am a DOCTOR OF MEDICINE by profession with medical license number

____________________, issued by the National Profession Commission (NPC);
(2) That I am the owner and proprietor of VENTURA’S MEDICAL CLINIC, located at
_____________________ ;

(3) That I am the personal doctor of MS. ANALYN V. TORRES, of legal age, single, Filipino
citizen, with residence address at ____________________;

(4) That I have been treating and managing her for VERTIGO since _______________ ;

(5) That her bouts of VERTIGO would at times be so severe that she would require bed rest
for more than two to three days;

(6) That on July 11, 2017, she visited my clinic at around __________ P.M. complaining of
weakness, nausea, and dizziness, which are the symptoms of VERTIGO;

(7) That after conducting proper observation and monitoring, I was able to ascertain that
she was indeed suffering from her illness VERTIGO, and prescribed to her the necessary
medicine she needed to take;

(8) That after her treatment, I issued her a MEDICAL CERTIFICATE dated July 11-13, 2017,
as I have advised her to take a bed rest for three (3) consecutive days to manage her
VERTIGO and advised her against moving up and travelling from her home;

(9) That I am issuing this Affidavit in order to clarify and verify what transpired during the
said consulation on July 11, 2017.

Affiant further sayeth naught.

MARIA ZENAIDA VENTURA

Affiant 

SUBSCRIBED AND SWORN to before me this _____ day of _______________ 2018 in

__________ City, Metro Manila, affiant exhibiting to her Community Tax Certificate No.
__________ issued on _____________ at ____________.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2018.