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T h a t I a m e x e c u t i n g t h i s a ff i d a v i t t o a t t e s t t o t h e
truth of the foregoing facts and to support my
________________________________________________.
FURTHER AFFIANT SAYETH NAUGHT.
Affiant
SUBSCRIBED AND SWORN TO BEFORE ME this _____________ day of
_____ 20___ in Quezon City, Philippines, affiant having
exhibited to me his/her Residence Certificate No. ___________________
_______________ issued in _________________________ on ________
20_________.
DOC NO.
PAGE NO.
BOOK NO.
SERIES OF
____________
____________
____________
____________
Notary Public
Until December 31, 20 ___
PTR No. _____________
Issued at _____________
Issued on _____________