Company Insurance

DECLARATION

I, Filipino, a resident of and a holder of Passport No hereby declare that I have read, understood and agreed to the following:

1. That, I the undersigned, is applying for work in

(hereinafter referred to as the “Company”) as a in Malta. 2. That, the contract is for one year renewable on a yearly bases on mutual consent subject to the approval of the Maltese government on permit renewal. 3. That, the company is applying for my work permit, visa and resident permit solely for employment purposes.

4. That, I am responsible for all expenses – visa processing, work permit, insurance and any other miscellaneous expenses – incurred in the course of my application and those expenses are not refundable.

5. That, I am responsible for my own accommodation and food in Malta and shall not hold the company responsible for these costs.

6. That, I am responsible for airline ticket expenses. 7. That, I am applying with the company with my own free will. 8. That, I declare that the only valid and legal contract of my employment is the one signed with the company, which contract has been approved by the Dier (Malta) and according to the Maltese labour laws and EU labour practices.

9. That, I also sgree that during my employment I shall respect and obey the company’s Rules of Engagement.

10. That, I am applying in Malta solely to work for the said company. Further, that, the company reserves the right to collect the resident permit card issued by the Government of Malta, upon my resignation with the company.

That, all of this, has been fully explained to me before my application started and I am signing this with full consent and volition.

Signed and attested today, of 201 .

SIGNATURE OVER PRINTED NAME