Republic of the Philippines )

Davao City ) s.s.

x-------------------------------------x

SWORN DECLARATION

I, {NAME}, Filipino, single, of legal age and a resident of Davao City, and designated as
the {POSITION} of ABC CARGO CORPORATION (the “Corporation”), a corporation duly
organized and existing under and by virtue of the laws of the Philippines, with principal
office at {ADDRESS}, do hereby certify the following:

1) That on {Date}, I attended an informal meeting with Mr. Beige, President of the
Corporation wherein I verbally admitted to have received the amount of {amount}
representing my additional commission, which I collected from the clients without the
Corporation’s prior knowledge;

2) That on {date}, Mr. Beige amicably asked me if the abovementioned amounts

representing my additional commission and which I admitted to have collected
without the Corporation’s prior knowledge can be included as deductions in the final
accounting of my receivables from the Corporation, and in response, I voluntarily and
intelligently agreed and acceded to Mr. Beige’s request;

3) That this has been made in good faith, verified, and to the best of my personal
knowledge and belief, is true and correct.

I HEREBY DECLARE UNDER THE PENALTIES OF PERJURY THAT THE

FOREGOING ATTESTATIONS ARE TRUE AND CORRECT.

[NAME]
TIN:

SUBSCRIBED and sworn to before me, in the City of Davao, this _____ day of
____________________, 2018 by _______________ with _____________ ID No.
__________________ issued at __________.
Notary Public

Doc. No.____
Page No. ____
Book No. ____
Series of 2023.