REPUBLIC OF THE PHILIPPINES)

____________________ ) S. S.

AFFIDAVIT TO SSS RE: SEPARATION OF EMPLOYEES

I, GIL H. PENAFLORIDA, married, Filipino citizen, of legal age, and resident of BLK 3 LOT 7 BELLBART VILL. EL
SOL SUBD. CABUYAO, LAGUNA, after been duly sworn to in accordance with law, do hereby depose and state:

1. That I am the President of LBI PHILIPPINES, INC. (the “Corporation”), a corporation duly organized and existing
under the laws of the Republic of the Philippines, with principal office at Blk 12 AA Lot 3 Brookeside Lane, Arnaldo
Highway, Brgy. San Francisco, General Trias, Cavite.

2. That LBI PHILIPPINES, INC. has the SSS Employer ID # 03-94775496-0 and we are registered at the SSS Alabang-
Zapote Branch.

3. That the following workers are no longer connected to LBI PHILIPPINES, INC. Please see below their respective
separation dates:

4. That the separated employees did not disclose such overdue loans to us as they were incurred before they were
employed at LBI PHILIPPINES, INC.

5. That I am aware of the nature, consequences and incurring liabilities (criminal/civil/administrative) for any falsity,
deceit, fraud, misrepresentation or non-disclosure made in connection with reporting the above-mentioned separation
of employees under the applicable laws, rules and regulations.

6. That I am executing this declaration for the Social Security System with the purpose of REMOVING the above-
mentioned people from our roster of employees as they have been separated already from the company long before.

IN WITNESS WHEREOF, I/we have hereunto set my/our hand this _____ day of November 2020 at _____________.

GIL H. PENAFLORIDA
President, LBI PHILIPPINES, INC.

ACKNOWLEDGEMENT
Republic of the Philippines)
_____________________ ) S.S.

BEFORE ME, a Notary Public for and in ______________________, this ______ day of ____________, personally appeared
the following:

Name Passport No. Place of Issue Date of Issue/Expiry

Known to me and to me known to be the same persons who executed the foregoing document and who acknowledged to me that
the same is their own and free and voluntary act and deed.

WITNESS MY HAND AND SEAL on the date and at the place first above-written.

Doc. No. _________

Page No. _________
Book No. _________
Series of 2020.