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Republic of the Philippines )

Davao City ) S.S.


I, __________________________________________, of legal age, Filipino, with address at _________________________

________________________________________, after having been sworn in accordance with law, hereby depose and state:

I am an employee of Aktiv Multi Trading Co., Phils., Inc. (AMTRAC) with business address at
___________________________ ;

The company has granted my request that I will resign in lieu of my termination from employmnent;

I am fully aware that the company is continuing its investigation of ____________ Division at AMTRAC of which I belong;

That notwithstanding my resignation from AMTRAC, I hereby undertake to fully answer any and all civil liabilities that
may be attributable to me after the said investigation;

I have executed his undertaking voluntarily and out of my own free will;

Subscribed and sworn to me this _____ day of 20_____, affiant exhibiting to me his ________ ID with No.
____________________ as competen proof of identity.

Doc. No. __________

Page No. __________
Book No. __________
Series of 20 __________