AFFIDAVIT OF AUTHORIZATION

I, AAA, Filipino, of legal age, and a resident of Davao City after having been duly sworn in
accordance with law, hereby depose and say, that:

1. I am a registered midwife previously employed at Department of Health duly

organized and existing under the laws of the Philippines with registered address at
J.P Laurel Avenue Davao City;
2. In view of my resignation, I authorize the Department of Health to deduct from my
separation pay all financial obligations with the agency, if there is/are obligation/s
present;
3. That this affidavit is being executed in order to attest to the truth of the foregoing
circumstances and for the purpose of complying with the Department of Health
requirements to receive my separation pay;

WITNESS WHEREOF, I have hereunto affixed my signature this 26th day of July 2023 at
Davao City, Philippines

BBB
Affiant
111111

REPUBLIC OF THE PHILIPPINES)

DAVAO CITY) SS.

SUBSCRIBED AND SWORN TO before me, a notary public in and for Davao City,
this 26 day of July 2023. The affiant, whom I identified through the following competent
th

evidence of identity: PRC ID 0173558 issued by Bureau of Internal Revenue, personally

signed the foregoing instrument before me and avowed under penalty of the law to the whole
truth of the contents of said instrument.

Doc. No.342
Page No. 70
Book No. 1
Series of 2023