Republic of the Philippines )

) S.S.

AFFIDAVIT OF FILING and SERVICE

I, _________________________, under oath, depose and state:

1. I am the counsel of __________________________________ in the case docketed

_____________________________________ entitled ___________________________, with office address
at _______________________________.

2. I filed and served copy of the ________________________________ in the case above-

captioned, pending before the ___________________________________ on the following parties
at their respective addresses and on the dates indicated below:

Mode of
Name Address Date of Service Service

3. The corresponding registry receipt/s is/are attached to the original pleading filed
with this Court.

IN WITNESS WHEREOF, I have hereunto set my hand this _______________________ in Makati

City, Metro Manila.

________________________________
Affiant

SUBSCRIBED AND SWORN to before me this _________________________ in _______________, Metro

Manila, affiant exhibiting to me his __________________________, bearing his signature and
photograph.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2018.