REPUBLIC OF THE PHILIPPINES )

CITY OF IMUS, CAVITE ) S.S.

AUTHORITY TO CLAIM SALARY AND OTHER COMPENSATION DUE

I, ______________ of legal age, single, Filipino citizen with residence address at 218 Sevilla St.
Woodsite 1 Bahayang Pag- Asa Pasong Buaya 2 Imus , Cavite, after having duly sworn in accordance to
law hereby depose and say;

1. That I am/ was an employee of ELU Security and Investigation Agency;

2. That for urgent reason(s) I have to stop working and go back home in our Province;
3. That by reason of this unexpected event I would be unable to claim or personally receive my
remaining salary and other possible compensation with the above states company;
4. That I hereby authorize Mr. ______________________to receive or claim the same in my favor;
5. That I am executing this affidavit and authorization to attest to the truth of the foregoing
circumstances and for whatever legal purpose this may serve.

In witness whereof I have hereunto set my hand this 22th day of February 2018 at City of Imus.

Affiant

Subscribed and sworn to before me this 22th day of February at City of Imus.

NOTARY PUBLIC

Doc No. :_________

Page No.:_________
Book No.:_________
Series of 2018.