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Republic of the Philippines )

Province of Surigao del Sur ) S. S.


Municipality of Madrid )

AFFIDAVIT

I, ANAMIE ORTIZ URBIZTONDO, of legal age, Filipino, married and a


resident of Purok 3, Songkit, Madrid, Surigao Del Sur, Philippines, after having been
duly sworn to in accordance with law, hereby depose and say: THAT–

1. I am applying for the position of Utility Worker in Municipal Circuit Trial


Court - San Francisco, Agusan del Sur.

2. I have no relatives within the third degree either of consanguinity or affinity


who is an incumbent employee in the subject branch;

3. Should the Supreme Court of the Philippines ascertain that I have relatives
in Municipal Circuit Trial Court - San Francisco, Agusan Del Sur, the
Supreme Court of the Philippines reserves the right to cancel the processing
of my application;

4. I understand that should I be employed, any misrepresentation on that matter is a


ground for an administrative case and termination;

5. This affidavit is executed to attest to the veracity of the foregoing


statements.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 13th


day of March 2023 at Madrid, Surigao del Sur, Philippines.

ANAMIE ORTIZ URBIZTONDO


Affiant

SUBSCRIBED AND SWORN TO before me this 13th day of March 2023 at


Madrid, Surigao del Sur, Philippines, by affiant who exhibited to me her Voter’s ID
with VIN. 6813-0005A-D1982AGO200000 as her competent evidence of identity.

Doc. No. ___;


Page No. ___;
Book No.___;
Series of 2023.

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