AFFIDAVIT OF CLAIM AND AUTHORITY TO DEDUCT

I, Jan Ray M. Caballo, of legal age, Filipino, single, and with address at lot 6 blk 1 Maglasang Subdv.
Cansojong Talisay City Cebu, after having duly sworn in accordance with law hereby depose and state that:

1. I am currently employed by Accenture, Inc. (the “Company” or “Accenture”), with principal

office address at 7th Floor Robinsons Cybergate 1, Pioneer St., Mandaluyong City.

2. My permanent residence, as reflected in my company records, located at lot 6 block 1 Maglasang

Subdv. Cansojong Talisay City Cebu, was damaged due to Typhoon Odette indicated in the
state of calamity declaration that occurred last 16 December 2021. The following areas of my
residence were severely damaged, namely:
a. Roof
b. Ceiling
c. ______________________
d. ______________________
e. ______________________

3. I understand that Accenture has a special Calamity Assistance benefit of Php 50,000 that is being
extended to me specific only to the above-mentioned calamity. I acknowledge that the Company
has the right to verify the truthfulness of my claim and for this purpose. I expressly consent to
Accenture, its agents, employees, or its duly authorized representatives to make inquiries, conduct
background checks or any other verification of information regarding my personal information
and the circumstances of my claim.
4. I acknowledge that any misrepresentation(s) in this claim may lead to disciplinary action up to and
including my termination from employment pursuant to Policy 0093 – Discipline Policy.
5. I am executing this affidavit to attest to the truth of the foregoing and for the purpose of
supporting my claim for this special Calamity Assistance.

Mandaluyong City, [DATE MONTH YEAR].

Jan Ray M. Caballo

Name of Employee:

Affiant

● SUBSCRIBED AND SWORN to before me this _____ day of __, 20, affiant having shown to me
his/her government issued ID No. ______________ issued on ______________at_____________.
Notary Public