Republic of the Philippines)

City
of
Cebu) S.S.

AFFIDAVIT

I, ADRIANO T. MARINAG Sr., Filipino, of legal age,

with address at Patupat, Barili, Cebu, Philippines, after
having been duly sworn to in accordance with law, do hereby
depose and state THAT:
1. I was previously employed at Carmen Copper
Corporation as Safety Officer from 2011 until May of
2016;
2. As a Safety Officer, part of my duties involved the
reception of leave applications with supporting
documents of employees of Carmen Copper Corp.
and endorsing them to the Timekeeper. The
Timekeeper encodes the application after approval
from the Department Head;
3. I know of MARK ANTHONY CUIZON, the
complainant in this Labor Case, as he was also
employed at Carmen Copper Corp. as Plant
Operator/Truck Driver in said company;
4. That said Mark Anthony Cuizon on these following
dates, submitted to me several Leave Applications
with his supporting documents as compliance with
the requirements for application for sick leave:
DATE

April 8,
2015
May 7,
2015
May 24,
2015
June 27,
2015

APPLICAT
ION

INCLUSIVE
DATES

Sick Leave

April 8 - May
8

Recovering from
Surgery
(Apendectomy)

Sick Leave

May 9 May
27

Recovering from
Surgery
(Apendectomy)

Sick Leave

May 25 June
28

Recovering from
Surgery
(Apendectomy)

Sick Leave

June 29 July
12

REASON

Recovering from
Surgery
(Apendectomy)

DOCUME
NTS
SUBMITT
ED
Leave
form,
Medical
Cert.
Leave
form,
Medical
Cert.
Leave
form,
Medical
Cert.
Leave
form,
Medical

Hospitalized
July 18,
2015
July 19,
2015

Sick Leave

July 14 July
18

Sick Leave

July 19 July
26

Recovering from
Hospitalization and
Pain from Surgery

Cert.
Leave
form,
Medical
Cert.
Leave
form,
Medical
Cert.

5. Upon receipt of the said Leave Applications, I

promptly forwarded them to JACKSON YPON, our
Timekeeper, for them to be signed by our
Department Head, BENJAMIN B. GARCIA, for proper
approval and encoding;
6. That I execute this Affidavit to attest and declare the
truth of the foregoing facts and for whatever legal
purposes that this Affidavit may serve.
IN WITNESS WHEREOF, I have hereunto set my hand
this ___ day of July 2016 at Cebu City, Philippines.

ADRIANO T. MARINAG, Sr.

_____ ID No. _____________

SUBSCRIBED AND SWORN to before me this ___ day

of July 2016 at Cebu City, Philippines. I hereby certify that I
have personally examined the Affiant and I am convinced
that he knowingly understood his affidavit. I further certify
that he voluntarily executed the foregoing statements.

Doc No. ___;

Page No. ___;
Book No. ___;
Series of 2016.