Republic of the Philippines )

Province of Davao del Norte )s.s.

City of Tagum )

AFFIDAVIT
I, ALEX M. ALCOBER, of legal age, Filipino, married and resident of Purok I,
Nabunturan, Compostela Valley Province, Philippines, after having been duly sworn to
an oath in accordance with law hereby depose and say that:

1. I am a bona fide member of PAG-IBIG Fund;

2. As such, my contribution was paid by my previous employers to wit;

a. North Davao Mining Corporation (Amakan, Maco, Compostela Valley

Province)
b. Soriano Fruits Corporation (Kamuning, Asuncion, Davao del Norte)
c. Sabena Mines (Camanlangan, New Bataan, Compostela Valley
Province)

3. Such actual contribution can be verified to PAG-IBIG through their payment

record system under my name ;
4. At present I am employed at Compostela Valley Province as Asst. Warden;
5. On my desired to avail the Provident Benefits Claim, as such I am requesting
to consolidate my contribution from my previous employers;
6. That I execute this affidavit to prove the truth of the foregoing facts.

IN WITNESS WHEREOF, I set forth my signature this ___________________at

Tagum City, Davao del Norte.

ALEX M. ALCOBER
AFFIANT
_________________

SUBSCRIBED AND SWORN TO BEFORE ME this _______________ at Tagum

City, Davao del Norte, with affiant exhibiting his above indicated Government ID.

Doc. No.: _____;

Page No.:_____;
Book No.:_____;
Series of 2017