AFFIDAVIT OF NO INTENTION TO

RETIRE/RESIGN

I, ____________________________, ____________________, a resident of

(Name) (Civil Status)

__________________________after having duly sworn to in accordance with law,

(Address)

hereby depose and say;

That I am presently working in _______________________located at
(Name of Institution)

_____________________________ as permanent ___________________________.

(Institution’s Address) (Designation)

That I will be ______ yrs old on _____________ with no intention or

(Age) (Birth Date)

pending application for retirement/resign while my loan obligation is still

outstanding with BDO NETWORK BANK.

That I further authorize the Disbursing Officer/ Principal/ Head of Office

to hold any of my receivables in favor of BDO NB if I will decide to retire or
separate from my office and my clearance shall not be issued not until I have
fully settled my loan obligation.

That this affidavit is done freely and voluntarily and all the foregoing
statements are true and correct to the best of my knowledge.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_____day of ________, ______________, Philippines.
 By: Conforme:

______________________
(Signature over Printed Name of Borrower) ________________________
Payroll In-Charge/Disbursing

______________________ ________________________
Co-Borrower1 Principal/Head of Office

_____________________
Co-Borrower 2

Conforme:

______________________
Branch Manager

Witnessed by:

_______________________ ____________________
Bank’s Representative Borrower’s Representative

_____________________
Date

REPUBLIC OF THE PHILIPPINES)

________ City ) S.S.

Before me, this ___ day of _________ 20__, personally appeared:

Name Comm. Tax Cert. No. Place & Date Issued

___________________ __________________________ ______________________

__________________ __________________________ ______________________
___________________ __________________________ ______________________

known to me to be the same persons who executed the foregoing instrument and acknowledged to
me that the same is their free and voluntary act and deed as well as the free and voluntary act and
deed of the principals they represent. This instrument, which consists of two (2) pages refers to the
Affidavit of No Intention to Retire, and signed by the parties and two witnesses.

IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my notarial seal at
the place and on the date first above written.

NOTARY PUBLIC
Book No.___________
Page No. ___________
Series of ___________