AFFIDAVIT

I, _________________________________, citizen of the Philippines/Austria, of

legal
age,
single/married,
presently
residing
at
________________________________________________, after having been
sworn according to law hereby depose and state that:
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IN WITNESS WHEREOF, I hereby affix my signature this ___ day of

_______________ 2012, in Vienna, Austria.

____________________________
Affiant
X-----------------------------------------------------------------------------------------------------------------------X
EMBASSY OF THE PHILIPPINES
VIENNA, AUSTRIA
SUBSCRIBED AND SWORN TO BEFORE ME this _____day of ________________, affiant
exhibiting
to
me
his/her
Philippine/Austrian
Passport
No.
______________________________________ issued on _________________________ in
______________________________________.
DOC. No.__________
PAGE No._________
BOOK No.____VII___
Series of ___2012___
SERVICE No. ______
O.R. No. __________
DATE ____________
FEE ______ 22,50-__