REPUBLIC OF THE PHILIPPINES)

MALOLOS CITY, BULACAN ) S.S.

AFFIDAVIT
(RE: INTERNATIONAL CERTIFICATE OF VACCINATION OR PROPHYLAXIS)

I, TREENA NAZARENO CASTOR of Legal age, Filipino Citizen, Single and with postal
and residence address at No. 721 Solana Bldg. Mirea Residences Santolan, Pasig City, after
having been sworn to in accordance with law hereby depose and say:

1. I am seeking employment abroad;

2. One of the requirements for my employment is my INTERNATIONAL CERTIFICATE

OF VACCINATION OR PROPHYLAXIS, Attached is a copy of said INTERNATIONAL
CERTIFICATE OF VACCINATION OR PROPHYLAXIS;

3. That I hereby attest to the authenticity and genuineness of the document and I
hereby agree to be liable and answerable to perjury and for falsification of public
document in the event that the document is found not in order;

4. That I am executing this Affidavit to attest to the truth and veracity of the above
foregoing facts and for all other legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand on this day of _______________

at MALOLOS CITY, BULACAN

TREENA NAZARENO CASTOR

Affiant

SUBSCRIBED AND SWORN to before me this day of ___________ at MALOLOS CITY,

BULACAN

Doc. No. _____;

Page No._____;
Book No._____;
Series of 2021