Republic of the Philippines )

City of Tuguegarao )S.S.

AFFIDAVIT

I, MARILOU C. LIM, of legal age, married, and a resident of

Balzain East, Centro II, Tuguegarao City, after having been duly sworn to in
accordance with law, do hereby depose and state that:

1. I am the Safety Officer of OML Construction located at Pagulayan

St., Balzain East., Centro II, Tuguegarao City, Cagayan.

2. On 6 February 2020, an accident occurred within the vicinity of OML

Construction where a certain CHARLIE TABORADA JR. died as a
consequence.

3. The said victim CHARLIE TABORADA JR. is not an employee of

OLM Construction but an employee of Engr. Lilia Herrera.

4. It was Engr. Lilia Herrera who shouldered all the medical expenses
incurred by the victim.

5. The management of OML Construction is unaware that the victim and

his companions entered the property of OML Construction. In fact,
they only learned the accident through Engr. Herrera in the evening on
6 February 2020.

6. It is for this reason that OML Construction did not submit the Safety
Accident Investigation Report.

7. I am executing this Affidavit to attest to the truth of all the foregoing

statements and for whatever legal purpose it may serve.

Affiant further sayeth naught.

IN WITNESS WHEREOF, I have hereunto set my hand this 26th

day of February 2020 at Tuguegarao City, Cagayan.

MARILOU C. LIM
Affiant

SUBSCRIBED AND SWORN to before me, this 26th day of

February 2020 at Tuguegarao City, Cagayan.

Doc No. ____;

Page No. ____;
Book No. ___;
Series of 2020.