PADILLA, PAULAINE, BUENAVENTURA

Name: _________________________  
CUSTOMER CARE REP1

Congratulations! In line with your successful application as _______________ in Legato Health Technologies, we are happy to 
inform you that we are pushing forward with the Pre‐Hire Stage of the process. 

If you have any questions, kindly email TAPreBoarding@legatohealth.com and DL-PreBoardingPH@legatohealth.com.

  CHECKLIST OF PRE‐EMPLOYMENT REQUIREMENTS 

Please submit the below documents within these times: 10am – 12nn and 4pm – 6pm 

Statutory Numbers 
Please submit the following within 5 days after the Job offer: ___________________. 

□ Photocopy of any proof of your SSS Number
• SSS ID
• SSS E1 New Member Form
• SSS E4 Member Data Change Request (If applicable)

□ Photocopy of any proof of your TIN Number
• TIN ID
• BIR Form 1905
• BIR Form 2316
• BIR Form 1902

□ Photocopy of any proof of your Philhealth Number
• Member Data Record

□ Photocopy of any proof of your PAG‐IBIG Number
• Member Data Form (PAGIBIG MDF)
• Pag-ibig Loan Statement of Account (from the
website or directly through Pag-ibig - this should
show the Pag-ibig number)

□ NBI Clearance or proof of request 
Other Documents needed 
Please submit the following 2 weeks before your start date: ___________________. 

□ Professional Regulatory Commission (PRC) License (If 
applicable)

□ USRN License (If applicable)

□ Stamped BIR Form 1905

□ Updated BIR Form 2316 (Previous Employment within the year)

□ Existing Government Loans
• Latest SSS Statement of Account
• Latest PAGIBIG Statement of Account
□ Educational Requirement
• CHED Certified Transcript of Records
• College Diploma
• Any proof of Highest Educational Attainment

□ Work History Requirement

• Certificate of Employment
• Employee Clearance
• Signed Resignation Letter - should be acknowledged by HR or TL (If 
COE and Clearance are not yet available)

□ Physical copies of 2x2 Picture (on White Background) 

Maxicare Requirements 

□ Photocopy of PSA Birth Certificate

□ Photocopy of PSA Birth Certificate of Dependent(s)

□ Photocopy of PSA Marriage Certificate (If applicable)
BDO – Payroll Requirements 
□ Submit BDO information through the google form via this link (https://forms.office.com/r/H73Cg56AbG)

□ Completed Application Form (submitted to the nearest branch)

□ Photocopy of 2 Government IDs with signatures

□ 1x1 ID Picture

□ Legato Payroll Receiving copy

Background Check 
Please complete the online application form at (https://forms.office.com/r/tmPvisra69) and Data Privacy and Consent Form within 5 days after the job

offer: ___________________ 

Medical Exam 
□ This should be completed within 5 days upon receipt of Medical Referral Slip.

□ Physical exam will only be taken at accredited clinics:

□ Accredited Clinic
• Myhealth clinics (Shangri-la, Venice, SM North, Alabang, Robinsons Manila)
• Friendlycare Clinics (Antipolo, Lagro, Cubao, Shaw)
• Fortmed Makati
• Center for Health Services, Inc. (CHSI) Pasig
• MC Lab (Shaw)

Please make sure to submit and accomplish your pre‐employment requirements on or before the deadline. Failure to submit on time will 
cause forfeiture of your employment at Legato Philippines. 

Kindly be advised that failure to comply with the BDO process before the deadline will also cause a delay in your payroll as this is part of
the pre-employment requirements.

Please also ensure that your declared statutory numbers (SSS, Philhealth, Pagibig, TIN) are correct. Incorrect statutory numbers provided
will cause a delay in the remittance. The mandatory contributions shall only be remitted when you have submitted a valid number and
thus the associated penalties will be shouldered by you and shall be deducted from your payroll.

I acknowledge the above statement and it is my responsibility to comply with Legato Philippines’ pre‐employment requirements. 

PBPADILLA
Signature: ______________________ 
02/02/2022
Date: __________________________ 
 Maxicare Enrollment Form

Employee's Full Name:

(Last Name, First Name and Middle
Name) PADILLA, PAULAINE, BUENAVENTURA
Birth Date
(mm/dd/yyyy): 01/13/1996 Date Hired: 02/07/2022
Civil Status: SINGLE Position Title: CUSTOMER CARE REP 1

INSTRUCTIONS: Please fill out indicating COMPLETE details. This form must be submitted to HR Department within 30 days from your joining date

FULL NAME Birthday Relationship to the

Gender Civil Status
(Last Name, First Name and Middle Name) (mm/dd/yyyy) Principal Member
PADILLA, GIAN PAOLO, SON
1 MALE 04/03/2010 SINGLE
BUENAVENTURA 09/19/2014 DAUGHTER
2
PALISAN, ANDREA PAOLA, PADILLA
FEMALE SINGLE
3 FEMALE
PALISAN, ANDY PENELOPE, PADILLA 06/20/2017 DAUGHTER SINGLE
4 FEMALE
PADILLA, NERISSA CONCEPCION, 12/06/1957 MOTHER
BUENAVENTURA WIDOWED
5

2 dependents shall be covered by the company

Employee may enrol additional one dependent only - at employee's cost

Signature PBPADILLA
Please note of the hierarchy of dependents that must be followed:
Minimum Age Maximum Age
Married Spouse - 1st 18 yrs old 65 yrs old
Children - 2nd day 1 21 yrs old

Single Parents - 1st 18 yrs old 65 yrs old

Siblings - 2nd day 1 21 yrs old

*Single (with common-law or same sex partner) Common Law - 1st 18 yrs old 65 yrs old
Children - 2nd day 1 21 yrs old

Single Parent Children - 1st day 1 21 yrs old

Parents - 2nd 18 yrs old 65 yrs old
Siblings - 3rd day 1 21 yrs old

Attach the following:

Deceased parent/s Copy of Death Certificate

Single Parent Copy of Solo Parent ID

Copy of CENOMAR (Principal and Dependent), Barangay Certificate of Cohabiting
*Common-law or same sex partner (Principal and Dependent), Affidavit of Co-habitation, Supporting Documents for
Non-enrollment of Parents and Siblings

Dependent With Exisiting HMO provider Copy of Maxicare Card

Copy of Certificate of Coverage (if other HMO Provider)

Please answer completely and accurately. If possible use black ink. Any change should be initialed by proposed insured and/or owner/payor.

Employer / Policyholder Policy Number

INSURED’S INFORMATION
Name (Title) (Last) (First) (Middle)
MS PADILLA PAULAINE BUENAVENTURA
Date of Birth (YYYY/MM/DD) Place of Birth Sex Male Civil Single Married
1996/01/13 PASIG Female Status Separated Widowed
Permanent Residence Address (Number, Street, City & Province)
48 SAMPAGUITA STREETDOLMAR SUBDIVISION KALAWAAN PASIG CITY Zip Code [1600 ]
Office Address (Number, Street, City & Province)
9th and 10th Floors, World Commerce Place Tower 2 36th St., cor. 11th Ave., Bonifacio Global City, Taguig Zip Code [ ]
Date of Birth Relationship of
Beneficiary/ies Place of Birth Revocable Irrevocable Citizenship
(YYYY/MMDD) Applicant
Primary PADILLA, 1957/1206 PATEROS
NERISSA CONCEPCION B. FILIPINO MOTHER
Contingent
PADILLA, NERISSA 1957/1206
CONCEPCIONPATEROS
B. FILIPINO MOTHER
Trustee to Minor Beneficiary/ies
PALISAN, ANDREA PAOLA,2014/0919
P. PASIG FILIPINO DAUGHTER
Note: All designated beneficiary/ies are deemed revocable unless stated otherwise.

Signed at By /PBPADILLA
Signature of Applicant
PAULAINE BUENAVENTURA PADILLA/ 02-02-2022
Date Witness
Signature over Printed Name
 HQP-PFF-093
(V04, 01/2019)

REQUEST FOR CONSOLIDATION/

MERGING OF MEMBER’S RECORDS

02/02/2022
Date

Dear Sir/Madam:

I would like to request for the consolidation/merging of my membership records with the
following information:

Pag-IBIG MID Number : 121130419013

Member’s Name : PADILLA PAULAINE BUENAVENTURA
Last Name First Name Name Extension Middle Name
Present Home Address : 48 SAMPAGUITA STREET DOLMAR SUBDIVISION KALAWAAN PASIG CITY

Marital Status :  Single/Unmarried  Widow/er  Annulled

 Married  Legally Separated
Contact Number : 09551295593
Employer/Business Name : LEGATO HEALTH TECHNOLOGIES
Employer/Business Address : 9th and 10th Floors, World Commerce Place Tower 2 36th St., cor. 11th Ave., Bonifacio Global City, Taguig City
Employer/Business Contact No. :
Purpose of Consolidation/Merging :  Short-Term Loan (STL) Application
 Application for Provident Benefits Claim
 Others, please specify

Previous Employer/Business Name Previous Employer/Business Address Inclusive Date(s)

1.
2.
3.
4.
5.

Requesting Pag-IBIG Fund Branch:

Requested by: Processed by:

PBPADILLA/ PAULAINE B PADILLA

Member’s Name and Signature Name and Designation of Authorized Signatory

Approved by:

Name and Designation of Authorized Signatory

 MUTUAL NON-DISCLOSURE AGREEMENT

THIS MUTUAL NON-DISCLOSURE AGREEMENT ("Agreement"), shall be effective as of __ 02/07/2022 (insert

date) and is made by and between Anthem, Inc. on behalf of itself and its Affiliates (defined herein) (collectively
“Anthem”) and _ PAULAINE B PADILLA (“Supplier”).

RECITALS

WHEREAS, the parties believe that they would mutually benefit by sharing with each other certain Confidential
Information (as defined herein) and believe it is in their mutual interest to ensure that all Confidential Information
shared by one party (the “Discloser”) will be safeguarded and carefully protected by the recipient (the “Recipient”).

NOW THEREFORE, in consideration of the recitals and respective promises of the parties contained herein, the
adequacyof which is hereby acknowledged, the parties, intending to be legally bound, hereby agree as set forth below.

AGREEMENT

1. “Affiliate” Defined. The term“Affiliate” in this Agreement shall mean any entity that controls, is controled
by or is under common control with a party, where control is defined as direct or indirect ownership of greater than
fifty percent (50%) of equity or other voting interest therein.

2. “Confidential Information” Defined. The term “Confidential Information” in this Agreement shall
mean any information not generally known by the public that relates to the existing or reasonably foreseeable
businessof the Discloser and/or its Affiliates, and which specifically includes, but is not limited to:

a) technical information, including functional and technical specifications, analysis, research, processes,
computer programs, source code, patent applications and files, methods, ideas, "know how" and the like;

b) business information, including financial information, internal market analyses and forecasts, sales and
marketing research, proposed products or services, design samples, research and development plans, test data
or other data, commercial or strategic planning, pricing, materials, plans, provider and beneficiary
demographics, provider-specific information, customer lists, customer demographics, and customer-specific
information (references to “customers” herein includes customers’ employees), business methods personnel
information, unannounced business relationships (that Discloser is negotiating or has entered into) , and the
like; and

c) Trade secrets.

3. Covenant Not to Disclose; Protection of Confidential Information. The Recipient hereby agrees that it
shall not use, commercialize or disclose the Confidential Information to any person or entity, except to its own
employees, contractor personnel, and to its attorneys, accountants, consultants and other professional advisors having
a “need to know”, and who are themselves bound by similar nondisclosure restrictions (collectively,
“Representatives”). If Recipient becomes aware of any disclosure or use not in compliance with this agreement,
Recipient shall notify Discloser in writing within three (3) days. The Recipient shall use at least the same degree of
care in safeguarding the Confidential Information as it uses in safeguarding its own confidential information. Each
party’s Representatives shall be bound to comply with all terms of this Section 3. Upon the request of a party, the
other party shall provide a written acknowledgement fromeach of its Representatives that said Representative isbound
by the terms of this Section 3.

4. Scope of Obligation. Except for Protected Health Information as defined in the Health Insurance Portability
and Accountability Act of 1996 and the regulations promulgated thereunder, Recipient’s obligation not to use or disclose
Confidential Information under this Agreement shall not apply to information that: (a) becomes generally available to
the public other than as the result of unauthorized disclosure by the Recipient or a third party; (b) is independently
developed by the Recipient without the aid, application or use of Confidential Information; or (c) was received by the
Recipient on a non-confidential basis prior to receipt from the Discloser or from a third-party lawfully possessing and
lawfully entitled to disclose such information. The burden of establishing that information was known, received, acquired
or independently developed by Recipient as provided above shall be on the Recipient.
Disclosure of Confidential Information shall not be precluded if such disclosure is (a) required pursuant to a valid
court order; or (b) in the opinion of legal counsel for the Recipient, is otherwise required by law, provided that in either
circumstance: (i) the Recipient shall furnish the Discloser with a copy of the demand, summons, subpoena or other legal
process to compel such disclosure; (ii) the Recipient shall give the Discloser reasonable prior notice of its intention to
disclose the Confidential Information in order to allow the Discloser an opportunity to seek appropriate protection; and
(iii) the Recipient shall take all reasonable steps to restrict the disclosure of the Confidential Information to the greatest
extent possible.

5. Proprietary Rights Legend. The Recipient shall not alter or remove from any Confidential Information,
any proprietary rights legend, copyright notice, trademark or trade secret legend, or any other legend or notice
identifying the material as Confidential Information.

6. Return or Destruction of Information. Upon termination of this Agreement, the Recipient shall return or
destroy the Confidential Information, and upon request, shall provide the Discloser with a certification of such return
or destruction; provided, however, that Recipient may retain copies of the Discloser’s Confidential Information for
archival and evidentiary purposes only, subject to the confidentiality obligations set forth herein.

7. Remedies for Breach of Confidentiality. The Recipient hereby acknowledges that its violation of the
restrictions imposed hereunder would cause irreparable harm to the Discloser and that remedies at law would be
inadequate to redress any actual or threatened violation of this Agreement. Each party agrees that, in addition to other
relief, the other party may seek to enforce the foregoing restrictions by temporary and permanent injunctive relief.
Any award of relief to the Discloser in an action in which the Discloser substantially prevails shall include recovery
of the Discloser’s costs and expenses of enforcement (including reasonable attorneys' fees).

8. Third Party information. Neither party shall disclose to the other any confidential information of a third
party in violation of an obligation of confidence to, or other proprietary right of, the third party. The Discloser shall
defend, indemnify and hold harmless the Recipient and the Recipient’s officers, directors, employees, contractor
personnel, and Representatives fromand against any claims, losses, liabilities, damages, judgments, costs, and
expenses (including reasonable attorney’s fees) arising out of or in connection with any claimby a third party that
the Discloser’s disclosure to the Recipient constituted a breach of a duty owed by the Discloser to the third party.

9. Term and Termination. This Agreement shall become effective on the date first written above and shal
terminate upon the happening of the earlier of (a) the written notice of either party to the other of its election, with or
without cause, to terminate this Agreement; or (b) the expiration of twelve (12) months from the date first written
above; or (c) the mutual execution of an agreement between the parties for the provision of services by one party to
the other. Each party agrees that its obligations undertaken herein as Recipient with respect to Confidential
Information disclosed to it, as well as any provisions of this Agreement, that by their terms, require performance after
the termination or expiration of the Agreement or have application to events that may occur after such terminationor
expiration, shall survive and continue after any termination or expiration of this Agreement.

10. Freedom of Action. Nothing in this Agreement is to be construed to preclude Recipient from using,
marketing, licensing, and/or selling any designs, work product, processes, methodologies software, data processing or
other information or material (collectively, “Material”) that is similar or related to those of Discloser, provided that
the same are independently developed without reference to Confidential Information disclosed by the Discloser under
this Agreement. Fromtime to time, Recipient may have explored, and in the future is free to explore, similar business
opportunities with other companies, and/or to pursue similar business opportunities on its own, including without
limitation developing and/or marketing and distributing Material in competition with the other party. Subject to the
specific obligations in this Agreement, such activities will not be considered a breach of this Agreement.

11. Relationshipof the Parties. With respect to all performance of this Agreement, each party, including its
employees, officers and agents, shall be considered an independent contractor, and not an employee, agent, partner,
or joint venturer of the other party. Except as expressly provided in this Agreement, neither party shall have any
right to act for, obligate or make commitments, express or implied, on behalf of the other.

12. Assignment. Unless it has first obtained the written consent of an officer of the other party, neither
party may assign this Agreement to any other person. Notwithstanding the foregoing, either party may, with
advance written notice to the other, assign or otherwise transfer its rights and obligations hereunder, in whole
or in part, to: (i) any of its Affiliates; or (ii) any entity surviving a transaction involving the merger,
acquisition, consolidation, or reorganization of the party, in which all or substantially all of the party’s assets
2
are sold, provided that the surviving entity is not a competitor of the non-assigning party. Either party is
required to provide advance written notice under this provision only to the extent permissible under
applicable law and the reasonable terms of the agreement(s) governing such merger, acquisition,
consolidation, reorganization, or asset sale. If advance written notice is not allowed, notice shall be provided
as soon as practicable. Upon receipt of notice of an assignment of this Agreement, the other party may
terminate this Agreement by providing the assigning party with thirty (30) days advance written notice of
termination. Any assignee of rights or benefits under this Agreement shall be subject to all of the terms and
provisions of this Agreement. Either party may subcontract any of its duties under this Agreement without
the prior written consent of other party; however, the party subcontracting the services shall remain
responsible for fulfilling its obligations under this Agreement.

13. Choice of Law, Forum. This Agreement shall be governed by Indiana law, without reference to or use of
any conflicts of laws provisions. The parties hereto agree that with respect to any disputes, actions, suits or
proceedings arising in connection with this Agreement, venue will be in the State of Indiana and in such event, the
parties hereby consent to the exclusive jurisdiction of the federal and state courts located in Marion County, Indiana.

14. Waiver. No failure or delay by either party to exercise any right or to enforce any obligation herein, and,
no course of dealing between the parties, shall operate as a waiver of such right or obligation or be construed as or
constitute a waiver of the right to enforce or insist upon compliance with such right or obligationin the
future. Waiver of any provision herein must be in writing.

15. Notices. All notices, requests, claims, demands, and other communications specifically required pursuant
to this Agreement.(each a “Notice”) shall be in writing, signed by an authorized representative of the party
providing the Notice, and shall be given or made by delivery in person, by a nationally recognized courier service
(with proof of delivery), by certified mail (postage prepaid, return receipt requested) or by electronic mail
containing a signed copy of the Notice in a separate attachment (with proof of delivery) to the respective party at
the following address set forth below or at such other address as such party may hereafter notify the other party in
accordance with this Section 15.

For Anthem:
Anthem, Inc.
____ _
____ _
Attention: ___

with a copy to
Anthem, Inc.
120 Monument Circle
Indianapolis, IN 46204
Attention: General Counsel

For Supplier:
____
____ PAULAINE B PADILLA
____
Attention: ___
with a copy to
____
____
____
Attention: ___

Each such Notice will be effective when actually received by the respective party if delivered in person, by courier,
or by electronic mail, with proof of delivery in each instance, or otherwise five (5) days after mailing. Notice to
Anthem at the address indicated shall constitute notice to Anthem and its Affiliates and notice by Anthem shall be
deemed to be on behalf of Anthemand its Affiliates unless otherwise specifically indicated in the notice.

3
16. Use of Name. Anthemreserves all rights to and control over its and its Affiliates’ names, symbols, service
marks or trademarks now existing or hereafter established. Supplier shall not use any such names, symbols or marks
for any purpose without Anthem’s prior written consent. Supplier reserves all rights to and control over its name,
symbols, service marks or trademarks now existing or hereafter established. Anthemshall not use any such names,
symbols or marks for any purpose without the prior written consent of Supplier.

17. General Provisions. This document constitutes the entire agreement between the parties with respect to the
subject matter hereof and supersedes all other communications, whether written or oral. This Agreement is expressly
limited to its terms and may be modified or amended only by a writing signed by an authorized representative of the
party against whom enforcement is sought. If any provision of this Agreement is deemed invalid or unenforceable,
such provision shall be ineffective only to the extent of such prohibition or invalidity without invalidating the
remainder of such provision or the remaining provisions of this Agreement. Headings are for reference purposes only
and have no substantive effect.

18. Execution; Counterparts. This Agreement may be executed and delivered in separate counterparts, each
of which will constitute an original, but all of which together will constitute one and the same instrument. Any
counterpart may comprise one or more duplicates, any of which may be executed by less than all of the parties provided
that each party whose execution is required executes at least one such duplicate. A copy of this Agreement, executed
on behalf of a party and transmitted to the other party by FAX, or in graphical-image formby email or other electronic
transmission, is to be deemed for all purposes to have been executed and delivered by that party to the other party. A
photocopy of a fully- or partially-executed original of this Agreement, including for example a FAX- or graphical-
image copy, will be admissible in evidence for all purposes in any proceeding as between the parties to the same extent
(if any) as the original.

IN WITNESS WHEREOF, and intending to be legally bound, the parties hereto have caused this Agreement to be
executed by their duly authorized representatives.

Anthem, Inc. Anthem, Inc.

Supplier Anthem Procurement Department
(required)

By: PBPADILLA By: By:

Signature Signature Signature
PAULAINE B. PADILLA
Printed Name Printed Name Printed Name
CUSTOMER CARE REP 1
Title Title Title

02/02/2022
Date Date Date