AFFIDAVIT OF NOTIFICATION AND DELETION

I, ____________, of legal age, Filipino, and with office address at Building,

_________________ City, after having been sworn in accordance with the law, hereby declare
that:

1. I am the Data Protection Officer (DPO) of _____________________. (“Company”) as

of the date of this Affidavit.
2. Sometime in 2018, a data incident occurred involving the personal information of
some of our employees (“Data Subjects”). The incident occurred when our healthcare
provider inadvertently sent your personal information to an incorrect email address;
3. Upon discovery and as instructed by the IT team of the Company, the Company
immediately requested our healthcare provider to cause the deletion of the email.
The Company also notified the Data Subjects of this incident;
4. Furthermore, the Company notified the National Privacy Commission (NPC) of the
said incident, and the same was docketed by the NPC as CIDBN No. ________.
5. In connection thereto, the NPC required the Company to submit a Post Breach
Report which was immediately complied with by the Company. Thereafter, NPC
required the Company to submit a proof of notification through an email dated
_______________.
6. Unfortunately, despite diligent efforts to retrieve the proof of notification and
deletion sent to the data subjects, we can no longer retrieve the proof of notification
and deletion;
7. I am executing this affidavit to attest to the truth of the foregoing facts and in
compliance with the requirements of the National Privacy Commission and for
whatever legal intents and purposes this may serve.

_____________________
AFFIANT

SUBSCRIBED AND SWORN to before this ___ day of December 2022 at

____________ City, affiant exhibited to me his ____________as his competent evidence of
identity.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2022.