Republic of the Philippines)

In the City of Davao

)s.s
X --------------------------------- x

AFFIDAVIT OF LOW INCOME

I, ________ of legal age, widow, Filipino and a resident of Indangan, Upper
Malagamot, Davao City, after having been duly sworn to in accordance with
law, do hereby depose and say that:
1. I am the same person executing this affidavit;
2. I am an applicant for membership for Nagkahiusa Settlers Association

at Indangan, Davao City;

3. My annual income is thirty six thousand (36,000) pesos;
4. The said wage is so meager and only enough to cover my familys
needs;
5. I am executing this affidavit to attest to the truth of the foregoing facts

and for whatever legal purpose this may serve best.

IN WITNESS WHEREOF, I have hereunto

_______________________, at Davao City, Philippines.

set

my

hand

this

___________________________
Affiant

______________

SUBSCRIBED AND SWORN TO before me this _____________________,

at Davao City, Philippines.