Republic of the Philippines)

Province of Negros Occidental) S.S.

City of Bacolod)
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AFFIDAVIT
I, AIRES S. CUSTODIO, of legal age, Filipino, with residence at
Pescador St., Brgy. Poblacion, Municipality of San Enrique, Negros Occidental,
Philippines, after having been duly sworn to in accordance with law, do hereby
depose and say:

1. That I am the owner of the following certificates:

a) CERTIFICATION from CORAZON LOCSON MONTELIBANO

MEMORIAL REGIONAL HOSPITAL (CLMMRH) that I worked
as STAFF NURSE, assigned at the Out-Patient Department
(OPD) from December 15, 2014 to November 14, 2016 and
at the 4th Floor West Tower Building from November 15,
2016 up to the present, issued by MARIA GELIA N. ONG,
DPA in her capacity as the Supervising Administrative
Officer, issued on April 18, 2017;

b) CERTIFICATION from DON SALVADOR BENEDICTO

MEMORIAL HOSPITAL that I worked as STAFF NURSE from
May 19, 2010 to May 19, 2012, issued by JOCELYN C.
GELOGO, RN. MBA. MN in her capacity as Nurse IV,
approved by GABBY P. PALACIOS, MD, MBA-HA in her
capacity as Chief of Hospital I, issued on February 26, 2018;

2. That the above-mentioned Certificates were issued in my name;

3. This affidavit is for the purpose of attesting to the truth of the foregoing
facts, and for whatever purpose it may serve.

AFFIANT FURTHER SAYETH NONE.

IN WITNESS WHEREOF, I have hereunto set my hand this 4th day of

July, 2018, at Bacolod City, Negros Occidental, Philippines.

AIRES S. CUSTODIO
Affiant

SUBSCRIBED AND SWORN to before me, this 2nd day of July, 2018, in
Bacolod City, Negros Occidental, Philippines, by AIRES S. CUSTODIO, who
exhibited to me her PRC ID (Reg. No. 0617386).

Doc No. _______

Page No. _______
Book No. _______
Series of 2018