REPUBLIC OF THE PHILIPPINES ) S.S.

CITY OF PASIG )

A F F I D A V I T

1) I, ________(name)_______, of legal age, married, Filipino, with principal office at

______________(location)___________, after having been duly sworn to in
accordance with law, hereby depose and state:

2) That I am the __________(position)_____of ____________(your company)____,

duly organized and existing under Philippine laws, with principal office at
______________(location)___________;

3) Our company is in the business of contracting____(Ex. Repair & Maintenance

Services jobs)______. It has all the qualifications required by law as a job or
independent contractor and is duly accredited by the Department of Labor and
Employment;

4) Our company has an existing contract/agreement with ___(ex. Manila Electric

Company)____;

5) For the period __(ex. January to March 2018)_____, our Company had paid the
salaries and wages due to its employees in accordance with the terms of our
contract with the ___(ex. Manila Electric Company)____;
Likewise, we have deducted from their salaries and wages the correct amount
corresponding to their contribution under the Social Security Law, the
Philippine Medical Care Act, Pag-ibig Fund, and BIR withholding Tax which
were remitted together with the employer’s share on the scheduled monthly
remittances to the concerned offices;

6) I hereby affirm our warranty that we have at all times complied with our
contract and obligations as an employer in accordance with the Employer’s
Compensation Act, Eight Hours Labor Law, Labor Standards (compliance to
wage rules and granting of 13th month pay and service incentive leaves) and
other labor legislations as well as existing rules and regulations including
provisions for the employees uniforms, identification cards, and safety devices
when so required by the job being performed;

7) I am executing this affidavit, under pain or perjury, to establish the truth of the
foregoing facts as well as for all legal intents and purposes.

FURTHER AFFIANT SAYETH NONE.

IN WITNESS WHEREOF, I have signed this (_____th) day of (May) 2018, at

Pasig City.

____________________
Affiant

SUBSCRIBED AND SWORN to before me this (______th) day of (May) 2018 in

______________________, affiant exhibited to me his Social Security System No._________

NOTARY PUBLIC

Doc. No. __________;

Page No. __________;
Book No. __________;
Series of __________;