Republic of the Philippines)

____________________ ) S.S.

AFFIDAVIT OF NO PENDING/FILED LEAVE OF ABSENCE AND/OR RESIGNATION

I, __________________________________, of legal age, Filipino, with permanent address at

_________________________________________________, after having been duly sworn to in accordance
with law, hereby voluntarily depose and say:

1. I am currently employed as ________________________________ in the

_____________________________;

2. That I am making this affidavit for the purpose of granting my application for a loan to Providers
Multi-Purpose Cooperative.

3. That I have no plan for applying leave of absence and/or resign before and/or after granting my
application for a loan to Providers Multi-Purpose Cooperative. However, In case of
EMERGENCY leave of absence WITHOUT PAY or WITH PAY, I will submit the copy of my
scheduled leave of absence to Providers Multi-Purpose Cooperative, and even I’m on leave, I will
continue to pay my Monthly Amortization.

4. Pls. check [√]appropriate box

That I have no pending or filed a leave of absence.

That I have no plan of applying a leave of absence after granting of my loan.

That I have no pending or filed resignation letter.

That I have no plan to resign after granting of my loan.

That I have a pending leave of absence, details of which are as follows:

Without Pay with Pay

Nature/specific leave of absences: _________________________________

(Specify)

5. That I am executing this affidavit to attest to the truth of the foregoing facts for the expeditious
processing of my loan to Providers Multi-Purpose Cooperative.

IN WITNESS HEREOF, I have set my hand and affixed my signature this _____day of
_____________, 20______ at ___________.

(Affiant)

SUBSCRIBED AND SWORN TO BEFORE ME this _______ day of _________ ___________, 20

______, affiant exhibited to me his/her Government Issued ID __________with No._________________
issued at ____________________ on ____________________.

Doc. No. ________

Page No. ________
Book No. ________
Series of ________ NOTARY PUBLIC