Republic of the Philippines)

City of Cebu )S.S.

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SWORN DISCLOSURE WITH UNDERTAKING

I, NIDA J. LAJATO, of legal age, married, and resident of c/o Aniceta Bldg. Osmeńa Blvd.,
Cebu City Cebu Philippines, after having been duly sworn to in accordance with the law do
hereby state:

1. That I am the Operation Officer of Carvel Trade & General Services, a sole
proprietorship with principal business address at Aniceta Bldg., Osmeńa Blvd., Cebu
City;

2. That Carvel Trade and General Services is rendering janitorial/maintenance services

to the following establishments: Cebu Doctor’s University Hospital Inc., Osmeńa
Blvd., Cebu City; Cebu Doctor’s University Inc., PVL Ave., NRA, Mandaue City; Cebu
South General Hospital Inc., Tuyan, Naga City; Cebu North General Hospital Inc.,
Talamban, Cebu City and Mactan Doctor’s Hospital Inc., Basak, Lapulapu City, Ormoc
Doctor’s Hospital Inc., Aviles Street, Ormoc City;

3. That Carvel Trade and General Services, its officers and owner or anyone of them,
are not operating or previously operating as a contractor under different business
name or entity;

4. That Carvel Trade and General Services, its officers and owner or any one of them,
have no pending cases for violations of D.O 174-17 and/or Labor Standards or with a
cancelled registration;

5. That Carvel Trade & General Services undertakes to pay the mandated benefits like
the Philhealth, HDMF, and remittance to BIR, etc., due to its contractual employees
and as proof of our compliance of payments of said benefits are its receipts.

In witness whereof, I have hereunto set my hand this_______________in Cebu City Cebu
Philippines.

NIDA J. LAJATO
(AFFIANT)
TIN: 181-412-278-000

SUBSCRIBED AND SWORN to before me this___________________, at Cebu City, Philippines,

with affiants exhibiting to me their respective valid ID’s as indicated below her name.