REPUBLIC OF THE PHILIPPINES)

CITY OF ROXAS )S.S.

AFFIDAVIT FACTUAL CIRCUMSTANCES

I, PICACHU, Filipino citizen, of legal age, single and a resident of Navarra Ave., Pob. Proper,
Manila, NCR, after being sworn to in accordance with law, depose and say that:

1.) That I am a licensed Medical Doctor in the Republic of the Philippines;

2.) That I passed the Physician Licensure Exams and acquired my license to practice medicine on
October 3, 2016, photo copy of the PRC ID is hereto attached as ANNEX "A";

3.) That I have been employed at Manila Hospital at Roxas Ave., Manila, NCR from 2016 to
2017 and 2019 up to the present as a Resident Physician, certificate of employment is hereto
attached as ANNEX "B"; and

4.) That I am executing this affidavit for my employment abroad as a nurse and for whatever
purpose it may serve.

IN WITNESS WHEREOF, we have hereunto affixed my signature this __________ in

Pres. Roxas, Capiz, Philippines.

PICACHU
Affiant
PRC ID: 0112233333432543634

SUBSCRIBED AND SWORN TO BEFORE ME a Notary Public of Metro Manila,

on this ______________________, affiant exhibited to me his
competent proof of identity on the place and date indicated above.
PDoc No. ___
Page No. ___
Book No. ___
Series of 2022.