Republic of the Philippines)

Province of __________________) S.S.

City/Municipality of ___________)
x --------------------------------------- x
AFFIDAVIT OF NO EMPLOYER-EMPLOYEE RELATIONSHIP
I, __________________, Filipino, of legal age, single, residing at
____________________, after being sworn in accordance with law, depose and state
that:
1. I hereby acknowledge to have received from XXX the amount of
___________________ ( Php ______________ ) as evidenced by ____ Check
No. _______ dated _____________, representing financial aid for the assistance
which I have rendered in XXX as an employee of XXX
2. I hereby declare that I have no claims whatsoever against XXX, its President,
members of the Board, officers or any of its staff as well as any demands and/or
cause of action of whatever nature arising out of my employment with MR. XXX;
3. I further agree that XXX shall not be made a party to any suit or proceeding
(Civil, SSS, PhilHealth, Medicare, Labor, etc.) to which either I, or my heirs and
assigns, may have against XXX arising out of my employment with him and/or
any claims or cause of action, either past, present, future, which I may have in
connection with the assistance I have rendered in XXX;
4. By signing this document, I hereby affirm that I am an employee of XXX and that
there is no employer-employee relationship whatsoever between XXX and I;
5. I hereby recognize that the above amount is being given out of the goodness of
XXX;
6. This affidavit is being issued to attest to the truth of the foregoing and for
purposes of affirming the absence of employer-employee relationship between
XXX and the undersigned.
__________________
Signature
IN WITNESS WHEREOF, I have hereunto set my hand this _ th of _________ at
Manila, Philippines.

_______________________

SUBSCRIBED AND SWORN to before me this __ th day of _________, 2015 at

Manila, Philippines, affiant exhibiting to me his _______________ issued at ________.
Doc. No. _______;
Page No. _______;
Book No._______;
Series of 2015.