Republic of the Philippines )

City of _____________ ) S.S.

AFFIDAVIT

I, , of legal age, Filipino, and a resident of , after having been sworn to in accordance with
law, hereby depose and state the following:

1. That I am an applicant/employee for permanent position of ;

2. That I have no relatives within 3rd civil degree, by affinity or consanguinity, among
the Appointing Authority or any of the HRMPSB Members, and that should BBB
discover that I have a relative within the same degree on any of the said Officers, it
shall be a ground for cancellation of my application;

3. That, upon appointment, I have no relatives within the 3rd civil degree, by affinity or
consanguinity, among the Officers of the Bank, including Branch Heads, Accountants
and Tellers within the Branch where I am applying for a position, if any;

4. That, while in Office, I shall immediately disclose in writing and to submit the same
to HRM within three (3) days from date of discovery or notice by HRM, should I
discover or be informed that I have relative(s) within 3rd civil degree to any of the
Officers mentioned in Item No. 2 and No. 3 above;

5. Failure to comply with all of the foregoing items except for Item No. 2, shall be a
ground for filing appropriate administrative offense against me.

AFFIANT FURTHER SAYETH NAUGHT.

In ______________, this ___ of ___________, ______.

___________________
Affiant

SUBSCRIBED AND SWORN TO before me this ___ day of ___________, ______, at the
______________, affiant exhibiting to me his ______________ with Serial No.___________,
issued on ___ of ___________, ______ at ______________.