Asia Corp.

EMPLOYEE INFORMATION
Name ROBERT JOSEPH GRATUITO

Commencement
Position PAYMENT ANALYST 06/15/2021
Date:

Medical Declaration *Please indicate “Y” for Yes and “N” for your answer ‘N’ Y N
Do you smoke? N
Are you currently pregnant (For female candidates only)
Are you currently undergoing any medical treatment or follow-up? N
Have you undergone or are about to undergo any surgical operation? N
Do you have any existing medical condition, physical impairment or substance N
dependence (i.e. dependence on alcohol, drugs etc. excluding prescription by a certified
medical professional)?
Foreign Countries you have worked, visited, transited in the past 14days? N
Cities in the Philippines you have worked, lived or transited in the past 14days? N
Have you been sick in the past 30 days? N
In the last 14 days, did you have any of the following: fever, colds, cough, sore throat, N
loss of smell and taste, muscle pain, headache or difficulty in breathing?
In the last 14 days, have you been in close contact or exposed to any person suspected N
of or confirmed with COVID-19? *
In the last 14 days, have you been in close contact with farm animals or exposed to wild N
animals?
If yes to any of the above questions, please specify:

Declaration and Data Privacy Consent Form:

By signing this form, I declare that the information I have given is true, correct, and complete. I understand
that failure to answer any question or giving a false answer can be penalized in accordance with law.

I also voluntarily and freely consent to the collection and sharing of the above personal information only in
relation to Finotec Asia Corporation’s compliance to Republic of the Philippines COVID-19 business operation
requirements and in accordance with the Data Privacy Act.

06/14/2021
ROBERT JOSEPH GRATUITO
Full Name & Signature Date