I, JUANA DELA CRUZ, of legal age, married, Filipino citizen and a
resident of ___________________, Philippines, after having been sworn to on oath in accordance to law, hereby depose and state that:
1. I am an overseas Filipino worker in Hongkong. I am employed for a
two-year contract from December 02, 2012 until December 2014, as a domestic helper to my employer Chan, Yun Tse;
2. However, on 23 April 2013, I went home to the Philippines and did
not finish my contract. I suffered verbal abused from my employer, she was so strict when it comes to cleanliness as she always orders me to repeat cleaning and as a result, I am sleeping very late at night. During meals, she only gave me little food and sometimes I don’t have a breakfast;
3. I therefore execute this affidavit to attest to the truth of the
foregoing facts and circumstance and for all legal intents and purposes that it may serve.
IN WITNESS WHEREOF, I have hereunto affixed my signature this
______________ in ___________________________, Philippines.
JUANA DELA CRUZ
Affiant ID No.
SUBSCRIBED AND SWORN TO BEFORE ME this ____________________ in
_________________________, Philippines, by the affiant who is known to me on the basis of competent document shown as proof of her identity.