Republic of the Philippines)

___________________ ) S.S.

AFFIDAVIT

I, (affiant), single, of legal age, resident of Poblacion, Malinao, Aklan, after having been
duly sworn to in accordance with law, do hereby depose and say:

That I have been previously employed as a nurse in ABC Medical Polyclinic, Saudi
Arabia from December 2012 to April 2015;

That I was not able to process the Registration Authority Verification Form with
Saudi Commission for Health Specialties (SCFHS);

That as per announcement issued by SCFHS, they will not process any forms since
it will consume time, and that the automated Good Standing letter will fill the purpose;

That the Certificate of Good standing is issued by said office is to be official and
valid and that it will cover all information contained in the verification form according to
SCFHS database;

That the registration is deemed valid and official insofar as SCFHS is not notified
of any misconduct or violation;

That I asked for clarification from the agency and was advised that I can submit a
Certificate of Good Standing from SCFHS together with a blank Registration Authority
Verification Form;

That the copy of the announcement issued by SCFHS is attached herewith as

Annex “A”;

That I am attaching a copy of the letter addressed to XYZ Company marked as

Annex “B”;

That the purpose of the letter is to comply with the documentary requirements in
relation to my application with said agency;

That I am executing this affidavit to attest to the truth of the foregoing facts and
for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereby affix my signature this 26th day of July, in the year 2018
in ______, Philippines.

Affiant
SUBSCRIBED and SWORN TO before me on the date and at the place indicated below. The affiant
exhibited to me her competent evidence of identity as indicated above.

Signed this 26th of July, 2018 at _______, Philippines.

WITNESS MY HAND AND SEAL.

__________________________
Notary Public

Doc. No. ________

Page No.________
Book No.________
Series of: ________