REPUBLIC OF THE PHILIPPINES)

PROVINCE OF PANGASINAN )S.S.

__________________ )
X------------------------X

AFFIDAVIT TO TRAVEL

THAT I, _________________, of legal age, Filipino citizens, and residing at

_________________, after having been duly sworn to in accordance with law hereby depose and
say:

That I am a government employee of the , Pangasinan;

That I am traveling to on , and will be returning

to the Philippines on , via Philippine Airlines;

That the purpose of my travel is personal and not work-related;

That I will personally provide for my financial expenses including airfare,

accommodation, and all necessary expenses I may incur during my intended vacation on
. 

By means of this affidavit, I hereby undertake to fully financially support myself during
this said travel without any obligation and intervention to my workplace.

That I am executing this affidavit to attest to the truth and veracity of the foregoing facts
and to make it known to the authorities' concern and for all legal intents and purposes.

IN WITNESS WHEREOF, we have hereunto set our hands this _______________at

Alaminos City, Pangasinan.

________________________________
Affiant
ID No. ______________________

SUBSCRIBED AND SWORN to before me, this ______________at Alaminos City,

Pangasinan.