Republic of the Philippines}

City of Cebu………………}S.S.

AFFIDAVIT

I, XXXXXXXXXX, Filipino, single, of legal age, and with an office address

XXXXXXXX, do hereby depose and state that:

1. I am the Corporate Secretary of XXXXXXXXX, which is engaged in the

business of XXXXXXXX;

2. Last XXXXXXXXX, I received a letter from Pag-IBIG reminding us of

our failure to remit the Pag-IBIG Membership Savings of our employees
and the employer’s counterpart for the period from XXXXXXXXXX.
However, said period was at the height of the COVID-19 pandemic, in
which the government required its citizens to stay at home at all times to
curb the possibility of spreading the virus further;

3. With this pronouncement and to protect our workers, we asked them to

stay at home, and stopped operations starting XXXXXXX. We only
started to begin operations again on XXXXX;

4. I am executing this affidavit to attest to the truth of the foregoing and to

apprise the said agency of the reason for my non-remittance during the
said period, and for any other legal purposes.

IN WITNESS WHEREOF, I am hereunto affixing my signature this ____

day of ______, 2022.

XXXXXXXXX
AFFIANT

SUBSCRIBED AND SWORN to before me this ____ day of _____ at Cebu

City, Cebu, with affiant exhibiting her _______ which expires on __________, and
issued at ________, as competent evidence of her identity.

Doc No.
Page No.
Book No.
Series of 2022