AFFIDAVIT

We, the undersigned, all of legal age, citizens of the Philippines, employees of GUIMBA
GENERAL HOSPITAL, INC., after having been sworn in accordance with law, do hereby depose and state:

1. That, on November 14, 2016, we were fraudulently, forcibly and under duress was made to sign
an affidavit waiving our right to receive back wages, future premium and over time pay from
GUIMBA GENERAL HOSPITAL, INC. and to work on a 26 days duty per month schedule, which we
are also questioning its validity;
2. That, the back wages are from the unpaid worked days, under payment of salaries and unpaid
premium and overtime pay that we are demanding from our employer;
3. That, our employer did not explain to us was what the purpose of the affidavit, prevented us
from further studying the affidavit or to have it explained to us by other person who might have
a better understanding of such documents;
4. That, the employer insisted the legality of the of the 48 hours work week without premium and
overtime pay by stating the following
a. That, the DOLE Regional Head supposedly told her that a 48 hours work week
without premium and overtime pay is lawful;
b. That, the DOLE Regional Head supposedly told her that the 48 hours work week
without premium or overtime pay is a the normal practice in medical institution in
Region 3;
c. That, the DOLE Regional Head supposedly corrected the DOLE Inspector who
conducted the visit. That her statement, that a 40 hours work week was the normal
working hours in a week and that in an event that the employees was made to work
more than the 40 hours, they would be entitled to premium or overtime pay was
not correct.
5. That, the Medical Director threatened those who will refuse to sign shall be terminated from
their employment, be removed from the personnel list or be removed from the schedule of
duties;
6. That, we were rushed to sign, without having time to read the document;
7. That, some were made to sign while they were attending the patients, even after refusing
multiple times, the clerk assigned to make them sign still insisted, distracting them from their
duties, possibly endangering the health and safety of the patients;
8. That, some of the signatories were confined in the Office of the Chief of Clinics, preventing them
from leaving and performing their duties until they have signed the aforementioned affidavit
possibly endangering the health and safety of the patients;

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 9. That, after we had the opportunity to fully comprehend the document we were forced to sign,
we immediately informed the Chief of Clinics that we are withdrawing our signatures, however
she refused;
10. That, we shall only be allowed to withdraw our signature if we can provide an alternative term
or conditions that she sees favourable to the management;
11. That, the act of the Management to have us sign an affidavit was to deceive and force us to
waive our right to back wages and additional compensation, which the DOLE may grant in a
Compliance Order based on our complaints and the findings of the DOLE Inspection.
12. That, the acts of the Hospital Management was a clear violation of our lawful rights.

Further Affiants sayeth none.

IN WITNESS WHEREOF, We/I have hereunto affixed our/my signature this ......... day of ..................... ,
20__ in ..................................... Philippines.

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(Signature of Affiant over Printed Name) (Signature of Affiant over Printed Name) (Signature of Affiant over Printed Name)

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(Signature of Affiant over Printed Name) (Signature of Affiant over Printed Name) (Signature of Affiant over Printed Name)

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(Signature of Affiant over Printed Name) (Signature of Affiant over Printed Name) (Signature of Affiant over Printed Name)

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(Signature of Affiant over Printed Name) (Signature of Affiant over Printed Name) (Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN before me this................ day of ......................................... 20___,

Notary Public

Doc. No. .........:

Page No. .........;
Book No. .........;
Series of 20__.

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