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Affidavit: Joselito M. Dimayacyac

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REPUBLIC OF THE PHILIPPINES)

BATANGAS CITY ) SS.

AFFIDAVIT

I, RONALDO G. BLANCO, of legal age, Filipino, married and with business


office address at Sitio Pulo, Barangay Balagtas, Batangas City, after having been
duly sworn in according to law, hereby depose and say:

That I am the Owner/Proprietor of RG BLANCO CONSTRUCTION &


GENERAL SERVICES with business office address at Sitio Pulo, Barangay
Balagtas, Batangas City and with SSS Employer ID No. 04-1029088-2;

That sometime on December 10, 2015, one of my employees in the person of


MR. PABLITO CRUZAT with SSS No. 04-3179992-2 whose job is to drive heavy
equipment, has filed his resignation effective said date and due to such, I accepted
his resignation and I issued in his favor a Certificate of Employment, photocopy of
which is hereto attached;

That I executed this Affidavit to confirm the truth of all the facts herein stated
and to inform the Social Security System that my said driver, PABLITO CRUZAT is
no longer employed at RG BLANCO CONSTRUCTION & GENERAL SERVICES
effective December 10, 2015 and further, for such other legal intents and purposes
this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of


January, 2016 at Batangas City.

RONALDO G. BLANCO
Affiant
TIN: 900-256-333-000

SUBSCRIBED AND SWORN TO before me this _____ day of January, 2016


at Batangas City.

Doc. No. _____ JOSELITO M. DIMAYACYAC


Page No. _____ Notary Public For & In The City of Batangas,
Book No. LXXXII Municipalities of Tingloy, Mabini, Bauan,
Series of 2016 San Pascual and San Jose
Until December 31, 2016
Rm. 3, Golden Luck Bldg,
Apacible Street, Batangas City
Roll No. 26881
PTR No. 2565419/Batangas City/ 01-4-2016
IBP No. 1011137/Batangas City/1-4-2016
MCLE Compliance No. IV-0003338;11-8-2011
TIN: 114-010-980
Commission No. 2015-31

/aff(resign_ sss_rgb_construction)

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