AnnexC3 Affidavit of Two Disinterested Persons

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CON-01721 (08-2022)

Republic of the Philippines )


City/Municipality of _____________) S.S.
Province of ___________________)

AFFIDAVIT OF TWO DISINTERESTED PERSONS


Contribution Penalty Condonation and Restructuring Program for
Household Employers

We, and , of legal


(Name) (Name)
ages with residence and postal address at ,
(Address)
in accordance with law, do hereby depose and say- THAT:

1. We personally know , a Household Employer duly


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(Name)
registered with the Social Security System (SSS), with Employer ID Number
, with Kasambahay/s duly hired on ,
(Employer ID Number) (DD Month YYYY)
and residential address at .
(Address)

2. As neighbors, we have personal knowledge of the Kasambahay/s,


that was/were under the employ
(Name/s of Kasambahay)
of our neighbor and that his/her/their employment as Kasambahay/s was/were
terminated effective .
(DD Month YYYY)
This/These is/are the same Kasambahay/s who was/were the subject of nonpayment
of SS contributions.

3. We also have personal knowledge of the financial difficulty that our neighbor is
facing due to the pandemic/natural calamity/fire/burglary/death of their
breadwinner, who provides for the financial needs of the family.

4. We are aware if his/her obligation of the monthly remittances to the SSS for and
on behalf of the Kasambahay/s but was not able to remit because of the financial
difficulties that his/her family has experienced during the past years due to
which is beyond his/her control.
(Reason/s of Financial Difficulty)

5. We are executing this affidavit to attest the truth of the above-mentioned facts
for all legal intents and purposes, it may serve.

AFFIANTS FURTHER SAYETH NAUGHT

Affiant Affiant
SUBSCRIBED AND SWORN to before me this ___ day of ________, 20__, the affiants
having shown to me their government issued identification card/s bearing the following
details:
Valid Proof of Date of Expiry/
Name
Identification Place of Issue

________________________________
Notary Public

Doc. No. :
Page No. :
Book No. :
Series of :

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