Republic of the Philippines )

City of Davao ) s.s.

AFFIDAVIT OF NON-LIABILITY

I, XXXXX, of legal age, Filipino, married and a resident of Brgy. Site, Brgy.
XXXX, XXXX, after having been duly sworn in accordance with law, hereby
depose and say:

1. That I am currently employed as Human Resource for XXXX assigned at

XXXXX;

2. That I intend to apply for a loan before the Government Service Insurance
System (GSIS);

3. That the said application of loan and the payment thereof as well as other
costs attributable to the loan shall be my personal obligation;

4. That in any event, such as retirement, severity from service and other
similar circumstances, the Department of Health as my employer, shall not
be liable for the payment of my obligation arising from the said loan;

5. That I execute this affidavit to attest to the truth of the foregoing.

IN WITNESS HEREOF, I have herunto affixed my hand this

________________, Davao City, Philippines.

XXXX
Affiant

Conforme:

XXXXXX
XXXXX

SUBSCRIBED and SWORN TO before me on the date and at the place

indicated below. The affiant exhibited to me his competent evidence of identity
as indicated above. Signed this ______________ at ________________,
______________________, Philippines. WITNESS MY HAND AND SEAL.

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Republic of the Philippines )

City of Davao ) s.s.
 AFFIDAVIT OF NON-LIABILITY

I, SHEILA MAY PALMERA, of legal age, Filipino, and a resident of B13, L5,
Jasmine St., Lavista Monte, Matina, Davao City, after having been duly sworn in
accordance with law, hereby depose and say:

6. That I am currently employed as Human Resource for Health of the

Department of Health (DOH) assigned at Jose Abad Santos, Davao
Occidental;

7. That I intend to apply for a loan before the Government Service Insurance
System (GSIS);

8. That the said application of loan and the payment thereof as well as other
costs attributable to the loan shall be my personal obligation;

9. That in any event, such as retirement, severity from service and other
similar circumstances, the Department of Health as my employer, shall not
be liable for the payment of my obligation arising from the said loan;

10. That I execute this affidavit to attest to the truth of the foregoing.

IN WITNESS HEREOF, I have herunto affixed my hand this

________________, Davao City, Philippines.

SHEILA MAY PALMERA

Affiant

Conforme:

ANNABELLE P. YUMANG, MD, MCH, CESO III

Regional Director
Davao Center for Health – Davao Region
Department of Health

SUBSCRIBED and SWORN TO before me on the date and at the place

indicated below. The affiant exhibited to me his competent evidence of identity
as indicated above. Signed this ______________ at ________________,
______________________, Philippines. WITNESS MY HAND AND SEAL.

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Republic of the Philippines )

City of Davao ) s.s.
 AFFIDAVIT OF NON-LIABILITY

I, KATHERINE JANE SANDARAN, of legal age, Filipino, and a resident of

Jose Abad Santos, Davao Occidental, after having been duly sworn in accordance
with law, hereby depose and say:

11. That I am currently employed as Human Resource for Health of the

Department of Health (DOH) assigned at Jose Abad Santos, Davao
Occidental;

12. That I intend to apply for a loan before the Government Service
Insurance System (GSIS);

13. That the said application of loan and the payment thereof as well as
other costs attributable to the loan shall be my personal obligation;

14. That in any event, such as retirement, severity from service and
other similar circumstances, the Department of Health as my employer,
shall not be liable for the payment of my obligation arising from the said
loan;

15. That I execute this affidavit to attest to the truth of the foregoing.

IN WITNESS HEREOF, I have herunto affixed my hand this

________________, Davao City, Philippines.

KATHERINE JANE SANDARAN

Affiant

Conforme:

ANNABELLE P. YUMANG, MD, MCH, CESO III

Regional Director
Davao Center for Health – Davao Region
Department of Health

SUBSCRIBED and SWORN TO before me on the date and at the place

indicated below. The affiant exhibited to me his competent evidence of identity
as indicated above. Signed this ______________ at ________________,
______________________, Philippines. WITNESS MY HAND AND SEAL.

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Republic of the Philippines )

City of Davao ) s.s.
 AFFIDAVIT OF NON-LIABILITY

I, CHRIS ANNA CAPILITAN, of legal age, Filipino, married and a resident

of Caburan Small, Jose Abad Santos, Davao Occidental, after having been duly
sworn in accordance with law, hereby depose and say:

16. That I am currently employed as Human Resource for Health of the

Department of Health (DOH) assigned at Jose Abad Santos, Davao
Occidental;

17. That I intend to apply for a loan before the Government Service
Insurance System (GSIS);

18. That the said application of loan and the payment thereof as well as
other costs attributable to the loan shall be my personal obligation;

19. That in any event, such as retirement, severity from service and
other similar circumstances, the Department of Health as my employer,
shall not be liable for the payment of my obligation arising from the said
loan;

20. That I execute this affidavit to attest to the truth of the foregoing.

IN WITNESS HEREOF, I have herunto affixed my hand this

________________, Davao City, Philippines.

CHRIS ANNA CAPILITAN

Affiant

Conforme:

ANNABELLE P. YUMANG, MD, MCH, CESO III

Regional Director
Davao Center for Health – Davao Region
Department of Health

SUBSCRIBED and SWORN TO before me on the date and at the place

indicated below. The affiant exhibited to me his competent evidence of identity
as indicated above. Signed this ______________ at ________________,
______________________, Philippines. WITNESS MY HAND AND SEAL.

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