Republic of the Philippines )

City of Santa Rosa

) S.S.
AFFIDAVIT
I, Clifford D. Decrito II, of legal age, single, Filipino citizen, and presently
residing at #232 Lucero St., Mabolo, Malolos City, Bulacan after having been duly
sworn to in accordance with law, do hereby depose and say:
1. That I am the sole proprietor of Dhays Baking Ingredients Store located
at B-207 L-1 PH-2 Mabuhay City, Mamatid, Cabuyao, Laguna;
2. That Dhays Baking Ingredients Store is a small family business being
manned only by household members;
3. That due to the small size of my business, I have not contracted any
person for services for any compensation as an employee or otherwise;
4. That I am also an employee of San Lazaro Hospital under its
Administrative Department;
5. That as such employee, I have been paying my Pag-IBIG membership
dues as I am deducted monthly of my Pag-IBIG contribution by my
employer;
6. That I have failed to register my business with the Pag-IBIG based on
my good faith belief that I have no responsibility to make further
contributions other than that being contributed from my employment
with San Lazaro Hospital;
7. That I am executing this affidavit to attest to the truth of all the
foregoing facts and statements and for whatever legal purpose it may
serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 24 th day of
August 2015 at the City of Santa Rosa, Laguna, Philippines.
Clifford D. Decrito II
Affiant
SUBSCRIBED AND SWORN to before me this 24th day of August 2015
in the City of Santa Rosa, Laguna, Philippines, the affiant exhibiting to me his TIN
418-938-072 issued at __________________________ on ________________.

ATTY. BLESSIE ROSE L. CARPENA

Notary Public
Until December 2016
IBP No. 999825; 5/25/15
PRT No. 2585922; 6/11/15
Roll No. 64719
Doc No. ____;
Page No. ___;
Book No. ___;
Series of 2015.