RTU-VPFA-HRDC-F-003 Control # ___________

REPUBLIC OF THE PHILIPPINES)

QUEZON CITY)

AFFIDAVIT

I, __________________________ of legal age, single/

married, Filipino and resident of ______________________________________
after having duly sworn according to law depose and say:

That I am presently employed as _______________________________

in the Rizal Technological University, City of Mandaluyong receiving
_____________________________________per ___________________________.

That I was not previously retired or given separation gratuity or

bonus by reason of the abolition of my position;

That this affidavit is being executed in accordance with the

provision of Memorandum No. 125 dated June 19, 1951 of the
Honorable, the Auditor General.

In WITNESS WHEREOF I hereunto set my hand this ____________

day of _____________________________________at ______________________.

_________________________________
AFFIANT

SUBSCRIBED AND SWORN to before me this ________________day

of ______________________________, at ________________________________,
Philippines, affiant exhibited to me his/her Residence Certificate No.
_____________________________ issued at ______________________________
on __________________________.

_______________________________________
Administering Oath

RIZAL TECHNOLOGICAL UNIVERSITY REVISED 0 Effectivity September 1, 2015