REPUBLIC OF THE PHILIPPINES)

CITY OF CALOOCAN ) S.S.

AFFIDAVIT OF TERMINATION OF EMPLOYMENT

I, ___________________, of legal age, Filipino, and with residence

and postal address at ______________________, after having duly sworn to in
accordance with law, hereby depose and state:

1. That I am a bona fide member of the Social Security System (SSS) with
assigned UMID CRN-_______________________;

2. That I was an employee of ______________________ with office

address at __________________ from ________________ up to
________________;

3. That I was terminated from employment effective

___________________ due to _________________;

4. That I cannot secure a Notice of Termination from my employer; and

5. That I am executing this affidavit to attest to the truth and veracity of the
foregoing statements and to support my application for unemployment or
involuntary separation benefit.

IN WITNESS WHEREOF, I hereby set my hand and affix my signature

this 13th day of February 2021 at Caloocan City, Metro Manila, Philippines.

___________________
Affiant

SUBSCRIBED AND SWORN to before me this 13th day of February

2021 at the City of Caloocan, Metro Manila, Philippines. Affiant having exhibiting
to me his __________________________.