JURAT

REPUBLIC OF THE PHILIPPINES) PROVINCE OF _______________) CITY/MUNICIPALITY OF ______ ) S.S.

[1] SUBSCRIBED AND SWORN to before me, in the municipality/ city of_____, this ____ day of ____, 2011, the affiant exhibiting to me his (any competent evidence of identity) issued by (issuing agency) on (date of issue) at (place of issue).

[2] JUAN DELA CRUZ NOTARY PUBLIC- Makati City Appointment No. ____ Until December 31, 2010 Roll no. ____ PTR no. ____, date of issue, place of issue IBP no. _____, date of issue, place of issue Office Address: Email: Contact Number: [3] Doc. No._____; Page No. ____; Book NO.____; Series of 2011