DISCLOSURE FORM

(For your safety and the safety of all employees of FIRST GLOBALTRANSIT INC., we ask that
you please fill out honestly and correctly the following form. Through this, we can monitor the
situation and make better informed decisions.)

Name : Jonathan B. Santos

Position : Financial service analyst 2
Address : 598 Nawasa line Brgy. guitnang bayan 1 san mateo, Rizal
Contact No. : 09518707820

Please indicate your recent date/s of travels and locations/destinations including local areas like
supermarkets, wet markets, food establishments etc. within the past 14 days

DATE PLACE REMARKS

March 29 Supermarket N/A

April 3 Wet market N/A

April 5 My Auntie’s house N/A

Have you been to a place (country, province, city or barangay) which are considered
COVID-19 hotspots or those with known COVID-19 cases within the past 14 days?
Please indicate the place visited.
NO
Have you been exposed to a known or suspected case of COVID-19. Please
explain.
NO

I affirm that the foregoing statements made by me are true. I am aware that if any of the
foregoing statements made by me are willfully false thereby subject my co employees to danger
of exposure to COVID-19, I am subject to the appropriate penalty that may be imposed by the
company including but not limited to lawsuit.

Jonathan Santos
Signature over printed name
Date: April 8 2020