Republic ol the Philippi.

nes)
Cily oi tulanila ) S.S

AFFIDAVIT OF WITHDRAWAL OF APPLICATION

of legalage single/married, Filipino citizen and with residence and

postaladdress at after having been sworn lo into
accodance wilh the law, do hereby dispose'and state.

1. The somelinre lapplied for overceas employment at TALENTSPHERE lNC.

(Formeily MEDTALENTS lNC.), a duly licensed recruilment and placemenlagency located
aicommercial Rm.202 2md floor MalateAdriatico Grard Residence 14I5 M. Adriatico St. tumita
Manila, Philippines.
2. That I applied to the said placement ageocy foremploymentio Kingdom ofsaudiArabia for {he position
ol Household Wofter.
3. That lsubmitied my passpod and otlrer documentary requi.ements to sald placement agency to
{acilities my placement.
4 That said placement agency did nol collect from me any amount lor my placement fee processing lee of
documents fee as consideration ofmy placement.
5. Thatfor personalreasoo, lcan no longerpuEue my application with $e said placementlee agency and
thus I decided to wilhdraw my passpod and othe. document submitted to the placement agency.
6. Thatthe placement agency.eleased to me my passport and the entire document pedaining to my
application without asking any consideralion whatsoever.
7. That I hereby releasing the said agency or any of its slalf, employees or ollicels from any liabilily, be it
adnrnistrative, civil or criminal, in as my recruilrnent for oveEeas employment is concemed.
B. That lexecuting this affidavit to atteslto lhe lrulh oflhe forgoing and lor alllegalintents and purpose
this may serve.

lN WIlNISS WIttiREOF, I havc ltercrlnro sormy band rhis dayot 2017ar

lvlAN _A.

AFFIANT
Passport No.:
Date of lssued:
Date of Expiry:
Place of lssued:

SUBSCRIBE ANo SWORN TO before me this _ day ol __ 2017 at [.4anila, philippines, affianr
exhibiied to me his/her passport with iniormation indicated below his/her name. Affiants furlhor a vow underthe
penalty oilawthat the slatement herein are lrue corect.

Doc No ;_
Page No.:
Book No :
Series oi20'17
RepubliD of lhe Philippines)
City of Manila )S.S

AFFIDAVIT OF WITHORAWAL OF APPLICATION

l, of legal age single/manied, Filipino citizen and wlth resldeoce and

postal address al after having been snom to into accodance '
with lhe law, do hereby dispose and stale.

,
1. That lam one oflhe applicantofTALENTSPHERE lNC. (Formerly l,ledtalents lnc], a duly licensed
recruitrnent and placement agency located at Commercial Rm, 202 2"d rloor Malate Adiatlco Grand
Residence r4l5 . adrialco St. Eflnlta Manila, Philippines,
z ftat I applied to lhe said placement agency for employmeot b KIxGDO[i OF SAUDI ARABAioT the
position of HOUSEHOLD WORKER.
3. That I submitted my passport and otherdocuments to said placement agoncy for lacilitate my
placement.
4. That I decided to witMtaw my passpori and o$ler documents I submitted to the placement agency for
Personalreason,
5. That me placement agency released to me he originalcopied of the following docum€nts.

o Passport
o Medical Certiflcate
o NBlCerlificates
o PDOS certilicated
o TESDA Ce(ilicare
o OWWA Certificate
o Olhers:_
6. That I am executing this atiidavit to attest to the lruth of the foregoing and lor all legal intents and
purpose f s mayseNe.

lN WITNESS WHER6OF, I have lcreqn(o

MANIJ,,\
set rny hand fhis __day ol_201? rt

AFFIANT
Passpon No.:
Date of lssued:
Date of Expiry:
Place of lssued:

SUBSCRISE AND SWORN T0 beforc me this _ day d _2017 atManila, Philippines, affanl
exhibiled to me his/her passport with infomation indicated below his/her name. Afliants further a vow under the
penalty oi law that the slatement herein arc true coffect.

Doc No.:_
PageNo.r_
BookNo.:_
Series of 201 7
Republic of rhe Ph ippines)
City of Manila )S.S

AFFIDAVIT OF WTHDRAWAL OF APPLICATION

of legalage single/mafiied, Filipino citizen and with residence and postal

address al after having been sworn to into accordance with the lau/, do
hereby dispose and slate.

'1. That lholding Philippines PasspodNo. lssued on _ at

2. That I received my passport and other document elated to my dedoyment abroad whiri I cannot
precede due to personal reason.
3. That I turthsr declare that I do not have any claims against TALENTSPHERE INC (formerly
I'iEDTALENTS lNC.) its officers and shff.
4. That I submit this alfrdavrt of qithdrawal as legal procedure.

lN Wl'I NESS WHEREO!, I have hereunto set my hand this day of 2017 at
MANILA.

AFFIANT
Passport No.:
Date of lssued:
Dale of Expiryl
Place of lssued:

SUBSCRIBE AND SWORN TO b€fore me this _ day 9f _2017 at Nlanila, philippines, amant
exhibited b me his/h€r passport with infomtio0 indicated below hi6/her name. Affiants fudher a vow under lhe
penalty of law lhat tfE statenent herein are true corcct

Doc No.:-
Page No.:_
Book No.:
Series ot 201 7