Republic of the Philippines )

City/Municipality of _____ ) S.S.

x----------------------------------------------------------x
AFFIDAVIT OF FAILURE TO
RETURN TO WORK
I, _________________________ of legal age, Filipino and residing at
________________________________after having been sworn to in accordance with
law hereby depose and state:
1. That I am an employee of Xcellcomms Enterprises since
___________________;

2. That I failed to return to work from _______________ to

________________ due to ________________________
______________________________________________
______________________________________________
______________________________________________;

That I am executing this Affidavit to attest to the truth of all the

foregoing statements, and for whatever legal intents and purposes this may serve.

FURTHER AFFIANT SAYETH NAUGHT.

________________________
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this _____________ day of
_____ 20___ in Quezon City, Philippines, affiant having exhibited to me his/her
Residence Certificate No. ___________________ _______________ issued in
_________________________ on ________ 20_____.
(NOTARY PUBLIC)
DOC NO. ____;
PAGE NO. ____;
BOOK NO. ____;
SERIES OF 2023.