Ako si _____________________________________, na may SS no. _______________________ may sapat na gulat at naninirahan sa _______________________________________________________ na may Tel. No. ___________________ matapos sumumpa na ayon sa batas, ay nagpapahayag ng mga sumusunod. 1. T: Ano ang pangalan ng iyong pinaglilingkurang kumpanya? S: ____________________________________________________________________________ 2. T: Saan ito maaaring matagpuan? S: ____________________________________________________________________________ 3. T: Sino ang kasalukuyang may-ari/pangulo? S: ____________________________________________________________________________ 4. T: Ano ang uri ng iyong trabaho? S: ____________________________________________________________________________ 5. T: Gaano ka katagal na naglilingkod sa kumpanya? S: Mula __________________ Hanggang __________________ Sahod: P_______________ 6. T: Kung tumatanggap kayo nd sahod, pumirma ba kayo sa “payroll”, “voucher” o kahalintulad nito? S: ____________________________________________________________________________ 7. T: Ilan ang manggagawa sa nasabing kumpanya? S: ____________________________________________________________________________ 8. T: Kayo ba ay napatala/na-ireport na ng nasabing kumpanya bilang kasapi sa SSS? S: ____________________________________________________________________________ 9. T: Binabawasan ba kayo ng kontribusyon para sa SSS? S: Oo _____________________ Hindi ____________________ Magkano: P_________________ 10. Nagbigay ba ng resibo o katibayan sa pagbabawas ng nasabing kumpanya? S: ____________________________________________________________________________ 11. T: Ang inyo bang karaingan ay tungkol sa: S: ____________________________________________________________________________ ____________________________________________________________________________ 12. T: Mayroon ba kayong mahalagang bagay na nais ipahayag? S: ____________________________________________________________________________ ____________________________________________________________________________ Ang nasabing kasagutan ay totoo at husto sa abot ng aking nalalaman at paniniwala at ito ay kusang loob at Malaya kong pagpapahayag.
__________________________ Testigo (pirma sa ibabaw ng pangalan)
______________________________ May Salaysay (pirma sa ibabaw ng pangalan)
LUMAGDA AT NANUMPA sa akin ngayong ika- _________________ ng _______________ 20___ sa ______________________ at ipinakita ang kanyang sedula bilang __________________ na kinuha sa _____________________ noong __________________________.
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Page 1 of 3. - 1 -. DIVISION OF SECURITIES. STATE OF COLORADO. Rev: 9/2013. COMPLAINT FORM. PROCEDURE FOR FILING A COMPLAINT. (Please read and detach). The Securities Division protects the public against fraud in the offers and sales of securities; u
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... student or parent appealing a Level One decision, or the lack. of a timely response after a Level One conference, to the Superintendent or designee, in accordance with. FNG(LOCAL) or any exceptions outlined therein. 1. Name. 2. Campus. 3. Address
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Page 3 of 11. 3. CERTIFICATION. This is to certify that a copy of the foregoing was mailed, postage prepaid, on the above. date to all counsel of record, as follows: John Hanks Jr., Esq. Aldrich, Hanks & Sheehan. 538 Preston Avenue, Suite 305. Meride
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