AFFIDAVIT OF CLAIM AND AUTHORITY TO DEDUCT
I, KAYE NICHOLE M. COSCA, of legal age, Filipino, single, and with address at Perez Blvd.,
Dagupan City, Pangasinan, after having duly sworn in accordance with law hereby depose and state that:
1. I am currently employed by Accenture, Inc. (the “Company” or “Accenture”), with principal
office address at 7th Floor Robinsons Cybergate 1, Pioneer St., Mandaluyong City.
2. My permanent residence, as reflected in my company records, located at Perez Blvd., Dagupan
City, Pangasinan, was damaged due to Typhoon Egay of Typhoon] indicated in the state of
calamity declaration that occurred last June 30, 2023.
3. I acknowledge that I need to submit all the required documents needed to support my Calamity
Benefit Claim, including a signed and duly notarized coy of this Affidavit of Claim and Authority
to Deduct, on or before September 30, 2023 or within 45 days from the date of calamity.
4. If I fail to submit a notarized copy of this Affidavit within 90 days from the date of calamity, I
hereby authorize Accenture to recover the Calamity Benefit that I received and deduct the same
from my payroll.
5. As proof of the damage to my residence I hereby attach a duly issued Barangay Certificate which
reflects my name, address, and the fact that my residence was indeed damaged by the calamity, as
well as photographs that depict the damage to my residence.
6. The said residence is the same residence I declared to HR as my permanent residence which
appears in my employee file.
7. I understand that I am only entitled to the Calamity Assistance specific to above mentioned
calamity only once. I further represent and warrant that aside from this claim I have not filed for
Calamity Assistance with the Company for the same incident.
8. I acknowledge that the Company has the right to verify the truthfulness of my claim and for this
purpose. I expressly consent to Accenture, its agents, employees or its duly authorized
representatives to make inquiries, conduct background checks or any other verification of
information regarding my personal information and the circumstances of my claim.
9. I acknowledge that any misrepresentation(s) in this claim or the submission of any fake
document(s) may lead to disciplinary action up to and including my termination from
employment pursuant to Policy 0093 – Discipline Policy.
10. I am executing this affidavit to attest to the truth of the foregoing and for the purpose of
supporting my claim for Calamity Assistance.
Binangonan, Rizal, 22nd day of August 2023.
KAYE NICHOLE M. COSCA
Affiant
SUBSCRIBED AND SWORN to before me this 22nd day of August 2023, affiant having shown to me
her government issued PHILIPPINE IDENTIFICATION CARD with ID No. 4895-1842-8570-4173 issued on
N/A at N/A.
Doc. No. 420;
Page No. 84;
Book No. LII;
Series of 2023. `
