Republic of the Philippines )
Quezon City. . . . . . . . . . . . ) s.s.
AFFIDAVIT OF FIT TO WORK
I, _____________-, Filipino, of legal age, single, and with residence
address at ______________-, Caloocan City, after having been duly sworn in
accordance with law, do hereby depose and say that:
1. That I am fit to work subject to the submission of my latest Medical
Certificate (CSC Form No. 211, Revised 2017) with attached original copy of the
pertinent laboratory results, I am fit to work as _____________
2. This Affidavit is being executed in order to attest to the truth of the
foregoing facts and not for the purpose of fraud, but in connection with my
application as ____________
IN WITNESS THEREOF, I have hereunto set my hand this 6th of
November, 2023 at Quezon City.
_____________
Affiant
SUBSCRIBED AND SWORN to before me this _______ day of
_____________, 20____ at ____________. Affiant appeared with her government
issued I.D. with no. ________________ issued on ____________________ at
___________________________ and acknowledged the foregoing affidavit to
be her free and voluntary act.
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2023.