CLASS C

Republic of the Philippines

City/Municipality of

AFFIDAVIT WITH WAIVER OF RIGHTS

I, , of legal age, single/married, Filipino and

presently residing at after having
been sworn according to law do hereby depose and say:

1. That I will be appointed as

pursuant to Board Resolution No. 90-009 dated February 16, 1990.

2. That on , I will assume the duties of the

abovementioned position pending receipt of various clearances and reports (such as but
not limited to Background/Character Investigation Report, GSIS Physical & Medical
Examination Report, audit and legal clearances) and completion of the required training/s
necessary for purposes of my employment.

3. That should I fail to complete the required training/s and should there be derogatory
information against me as later determined by LBP based on clearances issued by ALD,
IAG, concerned local and national agencies (such as but not limited to local PNP, RTC, Civil
Registrar) and Background/Character Investigation Report, I hereby waive my right to be
appointed or hired (regularized) to the aforementioned position as well as to all the
benefits and privileges appurtenant thereto except for compensation for services rendered
(actual number of days) by me, and immediately vacate said position.

4. That this Affidavit is being executed for the purpose of assuming the position and
reporting for work pending my completion/submission of abovementioned corporate
requirements for new hires.

Affidavit further sayeth none.

, Philippines

Signature of Employee

SUBSCRIBED AND SWORN to me this day of 20__

affiant exhibiting to me his/her Residence Certificate No. issued at
, Philippines on 20__.

Doc. No.
Page No.
 CLASS C
Book No.
Series of 20__.
 CLASS C

after having
 CLASS C
LAND BANK OF THE PHILIPPINES
ISO 14001 CERTIFIED
Official Depository of the Republic of the Philippines

DEED OF UNDERTAKING

I hereby declare that I have been duly informed of the restrictions in the
Land Bank of he Philippines on the hiring of relatives within the prohibited
degree of relationship (up to the third degree of affinity or consaguinity) as
provided for under its Management Committee Resolution No. 87-79 dated
November 23, 1987.

I hereby declare further, under the penalties of perjury, that I do not have
any relative in the Bank within said prohibited degree of relationship.

In the event that is later established, even if unknown to me now, that I

actually have an existing relative/s within the prohibited degree in the Bank, I
hereby acknowledge and confirm that the same shall be ground for the
immediate termination of my employment and separation from the service.

Signed this day of , 20__ in the

.

Signature over Printed Name

SUBSCRIBED AND SWORN to this day of 20__

affiant exhibiting to me his/her Community Tax Certificate No. issued at
, Philippines on .

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

LANDBANK Plaza, 1598 M.H. del Pilar cor. Dr. J. Quintos Sts.,
Malate, Manila 1004 · Tel. Nos. 522-0000 · 551-2200 · 450-7001
 CLASS C
www.landbank.com
CLASS C
 CLASS C

NON-DISCLOSURE AGREEMENT

Pursuant to my employment by the Land Bank of the Philippines (LANDBANK), I hereby agree and
acknowledge that:

1. In the course of my employment, classified information may be disclosed or may be made

available to me through whatever mode, which may or may not be relevant to the conduct of
my official duties and responsibilities, consisting of, but not limited to:

a. Business information such as customer records, deposit accounts, loans, trade, investment
data, transactions and financial data.

b. Technical information such as methods of access, processes, formulae, systems,

b. techniques, machines, computer programs and research projects.

Te2. I shall maintain the confidentiality of all information acquired by me or entrusted to be by

ch the Bank, its customers or business partners. That I am prohibited from making unathorized
nic disclosure of the same in accordance with Section 2 - Confidentiality of Information (Code of
al Conduct for LANDBANK Employees).
inf
or3. I shall protect these classified information in accordance with the provisions of the following
ma issuances and I agree to adhere to all policies and procedures set forth therein:
tio
n a. Pursuant to RA 6713 (Code of Conduct and Ethical Standards for Public Officials and
suc Employees), I shall not use or divulge confidential or classified information officially known
h to me by reason of my office and not made available to the public for my own interest,
as give undue advantage to anyone or prejudice the public interest;
me
tho b. Pursuant to Article 229 of Act No. 3815 (The Revised Penal Code), I shall not reveal any
ds
secret known to me by reason of my office or wrongly deliver paper or copies of papers in
of
my custody and which should not be published;
acc
ess
c. Pursuant to Sec. 55 of RA 8791 (The General Banking Law of 2000), I shall not, without
,
order of a court of competent jurisdiction, disclose to any unauthorized person any
pro
ces information relative to the funds or properties in the custody of the bank belonging to
ses private individuals, corporations, or any other entity;
,
for d. Pursuant to Sections 3 and 5 of RA 1405 (Secrecy of Bank Deposits Law), I shall not
mu disclose to any person other than those mentioned in Section 2 any information concerning
lae said deposits.
,
4.
sys I shall neither use nor cause to be used by others and/or disclose information in a manner
te inconsistent with the regular conduct of my official duties and responsibilities.
ms
,
 CLASS C

5. I agree to abide by the provisions of existing and future issuances of the Bank on Information
Security and Management of Technology Risk.

6. Upon termination of my employment and/or transfer to other unit/department:

a. I agree to return all documents and property of LANDBANK, including but not limited to
reports (hard and electronic copies), manuals, correspondences, customer records, and all
other materials and copies thereof relating to my official duties and responsibilities or
otherwise not related thereto which were obtained by me in the course of employment.
Further, I agree not to retain electronic or hard copies, notes or abstracts of the foregoing;

b. I shall continue to comply with the terms of this Agreement and maintain the
confidentiality of information and refrain from using such information in a manner that is
detrimental to the interest of LANDBANK;

c. LANDBANK may notify any future or prospective employer or third party of the existence
of this Agreement, and shall be entitled to full injunctive relief, including damages, for any
breach of confidentiality.

7. I have read and sufficiently understand the terms of this Agreement and I shall faithfully abide
by the provisions thereof. I am aware that a violation/transgression of any of the undertakings
set forth in this Agreement constitutes criminal, civil and administrative offense(s) punishable
by law, rules and regulations.

Signed this day of 20__ in , Philippines.

(Signature over Printed Name)

Employee No.
 CLASS B
ID INFORMATION SHEET

Dept./Field Unit: Region/Area: ____________

NOTE:
1. All information must be typewritten
2. Attach 1x1 latest colored picture with blue background 1x1
3. Affix signature using black ballpen picture
4. Your signature should not touch the edges of the box

Employee Name

Nickname Employee ID No. Blood Type TIN No.

Home Address

In case of emergency, please notify:

Name:
Address:

Contact No.:

Signature
 LAND BANK OF THE PHILIPPINES EMPLOYEES’ ASSOCIATION
DOLE-CSC REGISTRATION NO. 246
24th Floor LANDBANK Plaza
1598 M. H. Del Pilar cor. Dr. J. Quintos Sts., Malate, Manila
Tel. Nos. 522-0000 local 2525 & 2664; Fax No. 528-8529

MEMBERSHIP APPLICATION FORM

Date :

Name : Dept/Branch/Field Unit

Position : ___________________ ID No. : ______ Pay Grade : _____ Date of Entry : __________
Tel. No. : ______________ Mobile No. : ____________ Email Address : ______________________
Residence :
Civil Status : ______ Sex : ______ Age : ______ Blood Type : _______ TIN No. : ____________
Date of Birth : _________________________ Place of Birth :
Qualified Dependents:
Name Relationship Birthday Age
1.
2.
3.
4.
5.
6.

I hereby apply for membership in the Land Bank of the Philippines Employees’
Association (LBPEA). I agree to faithfully obey the rules and regulations as provided for in its
Articles of Constitution and By-Laws, policies set by the Board.

I hereby pledge to pay quarterly membership fee of P100.00

Applicants Signature
 RONALDO V. BONILLA NANETTE JARIÑO-LATI
Membership and Discipline Committee President