Republic of the Philippines )

City of _________ ) S.S.

SELF AFFIDAVIT IN CORROBORATION WITH TWO DISINTERESTED

PERSONS

I, _____________________________, of legal age, Filipino, married and a resident of

________________________, after having been duly sworn to in accordance with law, depose and
state that:

I was born to parents ++++++++++ on _____________ at ____________________________ as

evidenced by my Certificate of Live Birth duly issued by the Philippine Statistics Authority (PSA);

I have been employed in the following companies, to wit:

 _________________________________ for the inclusive period: Feb to Aug 2008;
 _________________________________ for the inclusive period: May to Dec 2007;
 _________________________________ for the inclusive period: Jan to Sept 2009;

I was registered/reported with PAG-IBIG Home Development Mutual Fund bearing the
following names, and was remitted of Pag-IBIG contributions by the respective companies for the
following period, to wit:

 _____________________________ as per __________________________ with inclusive Pag-

IBIG Contribution for the period: Feb to Aug 2008;
 _____________________________ as per __________________________ with inclusive Pag-
IBIG Contribution for the period: May to Dec 2007;
 _____________________________ as per _____________________________ with inclusive
Pag-IBIG Contribution for the period: Jan to Sept 2009;

However, I could not secure a certification from the above companies due to the travel
restrictions
within this quarantine period and I no longer have contacts with the Human Resource of the said
companies;

I am executing this Affidavit to attest to the truth of the foregoing facts and for whatever legal
purpose that this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _______________ in

____________________________, Philippines.

___________________________________
Affiant
SSS ID No. ___________________

CORROBORATION

We, ________________________ and ______________, both Filipinos, of legal age and

residents of __________________________, after having been duly sworn to in accordance with law,
do hereby depose and say that:

We personally know _____________________________ being his acquaintance for a long

period of time;

We know for a fact that he was born to parents __________________________________ as

evidenced by his Certificate of Live Birth duly issued by the Philippine Statistics Authority (PSA);

He was able to work in the following companies and was registered with PAG-IBIG Home
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Development Mutual Fund bearing the following names, to wit:



The above-stated names and the name _________________________ per Certificate of Live
Birth refer to one and the same person;

We are not related to him either by consanguinity or affinity;

We are executing this affidavit to attest to the truthfulness of the foregoing facts and for whatever
legal and beneficial purpose that this may serve.

IN WITNESS WHEREOF, we have hereunto set our hands this _____________ in __________,
Philippines.

__________________________ ___________________
Affiant Affiant

SUBSCRIBED AND SWORN to before me this ____________ in ____________________,

affiants exhibiting to me their competent evidence of identity indicated below their above-stated names.

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