(Jurat for an Individual Affiant)

SUBSCRIBED AND SWORN to before me, this _____________, by

_____________ who exhibited to me (his/her) Community Tax Certificate No.
_____________ issued at _____________, Philippines on _____________.
Notary Public
Doc. No. ______;
Page No. ______;
Book No. ______;
Series of ______;

I.

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES}

PROVINCE OF }
MUNICIPALITY }

BEFORE ME, this _______ day of _______, 2017 in the Municipality of

______________, Province of ______________, Philippines, personally
appeared ______________, with Residence Certificate No. ______________
issued at ______________, on ______________, with Residence Certificate No.
__________, on ______________, and B.I.R Tax Account No. ____________
known to me to be the same person who executed the foregoing instrument, and
he acknowledged to me that the same is free act and deed.

IN WITNESS WHEREOF, I have hereunto set my hand and affixed my

notarial seal, the day, year, and place above written.

Notary Public

My Commission expires December 31, 2019

IBP No. __________, 1/2/2019, Quezon City
P.T.R. No. ___________, 2/2/2001, Quezon City

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______;
 A. Verification

VERIFICATION

Republic of the Philippines)

City of _______________ ) s.s.

C.K. Hilfiger, after having been duly sworn in accordance with law,
deposes and states that:
1. He is the plaintiff in the pleading/document entitled
(pleading/document being verified)
2. He has caused its preparation
3. He has read it and the allegations therein are true and correct of his
own knowledge or based on authentic records.

(Sgd.) JUAN DELA CRUZ

PLUS: Jurat

NOTE: Pleadings required to be verified

1. All pleadings under the Rules of Summary Procedure
2. Complaints for
a. Forcible entry
b. Unlawful detainer
c. Replevin
3. Complaints with application for injunction or attachment
4. Answer to complaint or counterclaim based on actionable documents
5. Petitions for
a. Certiorari
b. Prohibition
c. Mandamus
d. Habeas Corpus
e. Change of Name

B. Certification against Forum Shopping

CERTIFICATION AGAINST FORUM SHOPPING

Republic of the Philippines)

City of _______________ ) s.s.
 C.K. Hilfiger, after having been duly sworn in accordance with law
deposes and states that:
1. He is the plaintiff in the case entitled (title of the case);
2. He certifies that he has not commenced any action or filed any
claim involving the same issues before any other court, tribunal or
quasi-judicial agency;
3. To the best of his knowledge, there is no such pending action or
claim;
4. If he should learn that a similar action or claim has been filed or is
pending he shall report such fact within five (5) days from the
discovery to this Honorable Court.

(Sgd.) JUAN DELA CRUZ

PLUS: Jurat

C. Combined Verification and Certification against Forum Shopping

VERIFICATION & CERTIFICATION AGAINST FORUM SHOPPING

I, C.K. Hilfiger, of legal age, do hereby state that: I am the Chief

Executive Office of Alis Di-yan Company and in such capacity, caused this
Complaint to be prepared; I have read its contents and affirm that they are
true and correct to the best of my own personal knowledge; I hereby certify
that there is no other case commenced or pending before any court involving
the same parties and the same issue and that, should I learn of such a case, I
shall notify the court within five (5) days from my notice.

IN WITNESS WHEREOF, I have signed this instrument on

_____________.

(Sgd.) JUAN DELA CRUZ

PLUS: Jurat

D. Combined Verification, Certification against Forum Shopping,

and Statement of Material Dates

VERIFICATION & CERTIFICATION AGAINST FORUM SHOPPING

 I, JUAN DELA CRUZ, of legal age, do hereby state that: I am the Chief
Executive Office of Alis Di-yan Company and in such capacity, caused this
Complaint to be prepared; I have received a copy of the
[Order/Resolution/Decision] of the Court on 13 April 2007; I have read its contents
and affirm that they are true and correct to the best of my own personal
knowledge; I hereby certify that there is no other case commenced or pending
before any court involving the same parties and the same issue and that,
should I learn of such a case, I shall notify the court within five (5) days from
my notice.

IN WITNESS WHEREOF, I have signed this instrument on

_____________.

(Sgd.) JUAN DELA CRUZ

PLUS: Jurat

E. Request for and Notice of hearing

REQUEST FOR & NOTICE OF HEARING

THE BRANCH CLERK OF COURT

Metropolitan Trial Court
Quezon City, Branch 39

Please submit the foregoing Motion to the Court for its consideration
and approval immediately upon receipt hereof and kindly include the same in
the court’s calendar for hearing on Friday, 13 April 2007 at 8:30 in the
morning.

ATTICUS FINCH
1 MockingBird Street
Timog Avenue, Quezon City

Please take notice that counsel has requested to be heard on Friday, 13

April 2007 at 8:30 in the morning.

(Sgd.) JUN CRUZ

Counsel for Defendant
2 The Firm
Laguna Street, Quezon City
F. Proof of personal service
Copy furnished through personal service:

Atty. Mitch McDeere

Counsel for the Defendant
2 The Firm
Laguna Street, Quezon City

G. Proof of service by registered mail (with Explanation for failure to

serve personally)

Copy furnished through registered mail:

Atty. Mitch McDeere
Counsel for the Defendant
2 The Firm
Laguna Street, Quezon City
Registry Receipt No. ________
Post Office ________________
Date _____________________

EXPLANATION

The foregoing (designation of pleading, motion, etc.) and its

attachment were served on Atty. Mitch McDeere by registered mail instead of
personal service as counsel for petitioner only has one messenger and
personal service would have resulted in the motion not being filed on time to
the detriment of petitioner.

(Sgd.) JANG GEUN SUK

Republic of the Philippines)

City of _______________ ) s.s.

AFFIDAVIT

I, JUAN DELA CRUZ, a messenger of Atty. Jang Geun Suk with office
address at __________________, after being duly sworn, deposes and states:

That on ______________________, I served a copy of the following

pleadings/papers by registered mail in accordance with Section 10, Rule 13 of
the Rules of Court:
 Nature of Pleading/Paper
________________________
________________________

in Case No. _________________ entitled ____________________ by depositing

a copy in the post office in a sealed envelope, plainly addressed to (name of
party or his/her attorney) at _______________ with postage fully paid, as
evidenced by Registry Receipt No. _____________________ attached and with
instructions to the post master to return the mail to sender after ten (10) days
if undelivered.

TO THE TRUTH OF THE FOREGOING, I have signed this Affidavit on

13 April 2007, in the City of Manila, Philippines.

(Sgd.) JUAN DELA CRUZ

Affiant

PLUS: Jurat

H. Place, date, signature, address, Roll number, IBP receipt number,

PTR number

City of Manila, 13 April 2007.

Atty. Mitch McDeere

Counsel for the
Defendant
2 The Firm, Laguna
Street,
Quezon City, Metro
Manila
Roll No.
IBP OR No., date and
place of issue
PTR OR No., date and
place of issue
 Republic of the Philippines
DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. 1
Quezon City, Manila
___________________
Complainant/s

CASE NO. _________________

– Versus –

___________________
Respondent/s

QUITCLAIM AND RELEASE

COMES NOW the undersigned complainant in the above entitled case before
this Office, respectfully manifest:

That for in consideration of the sum of ___________________________ (P

__________) in the settlement of my/our claim; as financial assistance and/or
gratuitously given by my/our employer, receipt of which is hereby acknowledge to
my/our complete and full satisfaction/. I/we hereby release and discharge the
_________________ and/or its officer, from any and all by way of unpaid wages,
separation pay, overtime pay, differential pay or otherwise as may be due me/us
incident to my/our past employment with said establishment. I/We hereby state further
that I/We have no more claim or cause of action of whatever nature whether past,
present or contingent against the said _________________ and/or its officer.

In view hereof, I/We hereby move for dismissal of the above entitle case and
further request that the same dropped from the business calendar of this office.

IN WITNESS WHEREOF, I/We hereunto set my/our hand/s this ____________

day of _______________ at _______________.

___________________
Complainant/s

PAID IN THE PRESENCE OF:

_______________________

SUBSCRIBED AND SWORN to before me this ___________________, day of

_______________ at _______________.
 DEED OF RELEASE, WAIVER AND QUITCLAIM
(with NOTICE OF SATISFACTION OF JUDGMENT)

KNOW ALL MEN BY THESE PRESENTS:

In exchange for the following lawful and valuable considerations, which I

acknowledged to have received with full knowledge and to my full satisfaction:

CONSIDERATIONS

(list of considerations received by the employee)

I, (name of the employee), of legal age, single, Filipino citizen and a resident
of 927 Quezon Avenue, Quezon City, under oath, hereby agree to the following
release, waiver and quitclaim:

1. I acknowledge that I have ceased to be an employee of REX INC. as of

November 3, 2017.

2. Subject to the full satisfaction of the above-enumerated consideration which

is promissory or conditional in nature (is there is any). I hereby totally release and
forever discharge the Company, its parent companies, its subsidiary companies, its
sister companies, affiliates, its investors, incorporators, stockholders, directors ad
other parties and entities related to the Company, from any claim, demand or
complaint arising from my employment, with the Company or under any labor and
employment law, rule and regulation, contract, principle of equity, or jurisprudence;

3. I hereby voluntarily withdraw of agree and consent to the immediate

dismissal of any claim, demand, complaint or lawsuit of whatever nature (whether
criminal, civil or administrative) which I have filed, initiated or instituted (or
caused to be filed, initiated or instituted) against the Company, its parent
companies, its subsidiary companies, its sister companies, its affiliates, its
investors, incorporators, stockholders, directors, officers, managers, supervisors,
employees, agents, representatives, consultants and other parties and entities related
the Company (if any);

4. I hereby likewise voluntarily withdraw, revoke, recall and/or recant any

accusations, allegations, statements that I may have uttered or written against the
Company, its parent companies, its subsidiary companies, its sister companies, its
affiliates, its investors, incorporators, stockholders, directors, officers, managers,
supervisors, employees, agents, representatives, consultants and other parties and
entities related the Company (if any);

5. I hereby declare that the above-enumerated consideration received by me

now or in the future (in case of promissory or conditional consideration, if there is
any) shall not be taken by me, or by my heirs and assignees, as an admission or
confession of fault, negligence or liability on the part of the Company, its parent
companies, its subsidiary companies, its sister companies, its affiliates, its
investors, incorporators, stockholders, directors, officers, managers, supervisors,
employees, agents, representatives, consultants and other parties and entities related
the Company;

6. I hereby admit that during my employment with the Company, I received

any and all salaries, compensations, benefits and refunds of whatever nature which
are due me under law, rule and regulation, contract, jurisprudence, principle of
equity, and Company policy and practice; and that the above-enumerated
consideration already represent my last, final, entire and only remaining pay or
claim.

7. Should I found judicially to be entitled to any further or additional awards

or amounts (such as when this Deed is already too late or ineffective to cause the
dismissal or withdrawal of my pending claim, demand, complaint or lawsuit of
whatever nature), I hereby completely and voluntarily waive my right to receive the
same or cause the execution of such judgment, and this Deed shall serve as my
Notice of Satisfaction of Judgment, which I consent to be submitted to the
concerned court or government agency for the final closure of the case.

8. I also declare that I have not been nor I am now suffering from any work-
related illness, disease, injury or disability attributable to my employment with the
Company;

9. I have read this document in its entirety, and understood it completely as it

is in English, a language I learned in school. I was given an opportunity to ask
questions and to consult with a lawyer of my choice before I made my decision to
sign this Deed. This document was also explained to me by (name of the company
officer who explained this document) before I willingly and voluntarily placed my
signature that this document is a complete settlement of all my claims as narrated
above; and

10. In the event that the above-narrated promissory or conditional

consideration (if there is any) is not fulfilled for whatever reason. I hereby agree to
strictly confine and limit my claims, demands and complaints to the enforcement,
implementation or performance of such above-narrated promissory or conditional
consideration (of any).

Signed this (date signed by the employee) at (place signed by the employee)

(signature of employee over his/her printed name)

(description of employee’s valid government issued identification with

photograph and signature. NOTE: a photocopy of said identification should be
attached to this Deed.)

Witnesses:

(signature of 1st witness over his/her printed name)

(signature of 2nd witness over his/her printed name)
 (NOTE: I strongly suggest that one of the witnesses should be an officer of the
Department of Labor and Employment or DOLE with his/her position and office
clearly indicated. I also suggest that several photographs be taken of the signing of
Deed by the employee and the witnesses, and then these should be attached to this
Deed.)

REPUBLIC OF THE PHILIPPINES}

___________________} s.s.

ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in __________________,

Philippines, this ___________________, personally appeared:

NAME OF EMPLOYEE GOVERNMENT ISSUED IDENTIFICATION

(name of employee) ___________________

known to me and to me known to be the same person who executed the
foregoing instrument, and (he/she) acknowledged to me that the same is (his/her) own
voluntary act and deed.

Witness my hand and seal.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______;

(Note: I also strongly suggest that several photographs be taken of the oath
taking of the employee before the notary public, and then these should be attached to
this Deed.)
 (Promissory Note Simple Form with Interest)
PROMISSORY NOTE
P_____________

FOR VALUE RECEIVED, I promise to pay without need of demand to the

order of __Payee__, at his office at _____________, the principal amount of
PESOS: __________________________ (P_____________), on or before
_____________. In addition to the foregoing, I promise to pay monthly interest
at the rate of _____________ (_______%) percent, without need of demand,
starting from the month of _____________ until this note is fully paid.
__Date__, _____________, Philippines.
REPUBLIC OF THE PHILIPPINES)
Makati City ) SS.

AFFIDAVIT OF DISCREPANCY IN NAME

I, _____________________, of legal age, married, and with address at

______________________________________________________, under oath, state:

1. THAT my name is ____________________ as stated and registered in my

birth certificate issued by office of the Civil Registry of ______________________. A
copy of my birth certificate is hereto attached as ANNEX “A”;

2. THAT the name ___________________also appears in my passport which

was issued based on the data appearing in my birth certificate. A copy of the page of
my passport where my name and picture appears is hereto attached as ANNEX “B”;

3. THAT since childhood, my friends and acquaintances call me ________and

thus since then I have been accustomed to using the name ____________________in
my personal records, transactions and communications;

4. THAT the name ____________________ and _____________________ refer

to one and the same person, the herein Affiant;

5. THAT I am executing this Affidavit to attest to the truth of the foregoing facts
and to use the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this

_________________ at Makati City.

________________________
Affiant

SUBSCRIBED AND SWORN to before me this _______________ at Makati

City, Affiant exhibiting to me his Passport bearing No.
______________________________ issued at ______________ on
_________________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______;
 CONTRACT TO SELL
KNOW ALL MEN BY THESE PRESENTS:

This CONTRACT TO SELL, made and executed this ____ day of _________, 20__
by and between:

(NAME OF SELLER /VENDOR), of legal age, single/married to (Name of

spouse if any), Filipino, and with residence and postal address at (Address),
hereinafter referred to as the "SELLER/VENDOR";

-AND-

(NAME OF BUYER/VENDEE), Filipino and with residence and postal address

at (Address), hereinafter referred to as the "BUYER/VENDEE".

WITNESSETH;

WHEREAS, the SELLER/VENDOR is the absolute and registered owner of a

parcel of land consisting of LAND AREA IN WORDS (000) square meters, more or
less, located at (Address of property to be sold) and covered by Transfer Certificate
of Title No. (TCT Number) issued by the Registry of Deeds of (Name of Town
or City);

WHEREAS, the BUYER/VENDEE has offered to buy and the SELLER

/VENDOR has agreed to sell the above mentioned property under the terms and
conditions herein below set forth;

NOW THEREFORE, for and in consideration of the total sum of (Amount in

words) (Php: 000,000.00) Philippine Currency, and of the covenants herein after set
forth the SELLER/VENDOR agrees to sell and the BUYER/VENDEE agrees to
buy the aforesaid property subject to the following terms and conditions: (Note:
Terms and Conditions below are sample only, please revise)

1. The total consideration shall be One Million (Php: 1,000,000.00) PESOS,

Philippine Currency, payable as follows:
a) The amount of THREE HUNDRED THOUSAND (Php: 300,000.00) PESOS,
representing earnest money shall be payable by the BUYER/VENDEE to
the SELLER/VENDOR upon signing of this Contract to Sell;

b) The remaining balance in the amount of SEVEN HUNDRED THOUSAND

(Php: 700,000.00) PESOS, shall be paid in Cash on or before ___________, 20__.

c) In case the check representing the payment for the balance provided in
paragraph b hereof, is dishonored by the drawee bank, the earnest money in the
amount of THREE HUNDRED THOUSAND (Php: 300,000.00) PESOS, shall be
forfeited in favor of the SELLER/VENDOR.
 2. Capital Gains Tax and Real Estate Tax, shall be for the account of
the SELLER/VENDOR;

3. Documentary Stamps Tax, Registration Fee, registration expenses, and all

other miscellaneous fees and expenses shall be to the account of
the BUYER/VENDEE;

4. Possession to the subject property shall be delivered by

the SELLER/VENDOR to the BUYER/VENDEE upon full payment of the
total consideration;

5. Upon full payment of the total price, the SELLER/VENDOR shall sign and
execute a DEED OF ABSOLUTE SALE in favor of
the BUYER/VENDEE. TheSELLER/VENDOR shall likewise execute and/or
deliver any and all documents, including but not limited to the original copy of
Transfer Certificate of Title, Tax Declaration and all other documents necessary for
the transfer of ownership from SELLER/VENDOR to the BUYER/VENDEE.

IN WITNESS WHEREOF, the parties have hereunto affixed their signatures, this
___ day of ____________, 20__ at _________________________, Philippines.

(SELLER/VENDOR) (BUYER/VENDEE)
Name Name

WITH MARITAL CONSENT:

________________________ _________________________
Name of Seller/Vendor's Spouse Name of Buyer/Vendee's Spouse

SIGNED IN THE PRESENCE OF:

__________________________ ____________________________

ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES) _____________________________ ) SS.

BEFORE ME, a Notary Public, this ____________day of ________________,

personally appeared the following:

Name CTC Number Date/Place Issued

(Name of Seller/Vendor) 10000000 February 5, 20__ / Pasay City

(Name of Buyer/Vendee) 10000000 January 14, 20__ / Quezon City
This instrument, consisting of ___ page/s, including the page on which this
acknowledgment is written, has been signed on the left margin of each and every page
thereof by the concerned parties and their witnesses, and sealed with my notarial seal.

IN WITNESS WHEREOF, I have hereunto set my hand the day, year and place
above written.

Notary Public

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______;
 LEASE CONTRACT

KNOW ALL MEN BY THESE PRESENTS:

This CONTRACT OF LEASE is made and executed at the City of _____, this day
of _______________, 20____, by and between:

(NAME OF LESSOR), of legal age, single/married to (Name of spouse if any),

Filipino, and with residence and postal address at (Address), hereinafter referred to
as the LESSOR.

-AND-

(NAME OF LESSEE), Filipino and with residence and postal address at

(Address), hereinafter referred to as the LESSEE.

WITNESSETH; That

WHEREAS, the LESSOR is the owner of THE LEASED PREMISES, a residential

property situated at (Address of property to be leased);

WHEREAS, the LESSOR agrees to lease-out the property to the LESSEE and the
LESSEE is willing to lease the same;

NOW THEREFORE, for and in consideration of the foregoing premises, the LESSOR
leases unto the LESSEE and the LESSEE hereby accepts from the LESSOR the
LEASED premises, subject to the following:

TERMS AND CONDITIONS

1. PURPOSES: That premises hereby leased shall be used exclusively by the

LESSEE for residential purposes only and shall not be diverted to other uses. It is
hereby expressly agreed that if at any time the premises are used for other
purposes, the LESSOR shall have the right to rescind this contract without
prejudice to its other rights under the law.

2. TERM: This term of lease is for ONE (1) YEAR. from (Date) to (Date)
inclusive. Upon its expiration, this lease may be renewed under such terms and
conditions as my be mutually agreed upon by both parties, written notice of
intention to renew the lease shall be served to the LESSOR not later than seven (7)
days prior to the expiry date of the period herein agreed upon.

3. RENTAL RATE: The monthly rental rate for the leased premises shall be in
PESOS: AMOUNT IN WORDS (P 00,000.00), Philippine Currency. All rental
payments shall be payable to the LESSOR.

4. DEPOSIT: That the LESSEE shall deposit to the LESSOR upon signing of
this contract and prior to move-in an amount equivalent to the rent for THREE (3)
MONTHS or the sum of PESOS: AMOUNT IN WORDS (P 00,000.00), Philippine
Currency. wherein the two (2) months deposit shall be applied as rent for
the 11th and 12th months and the remaining one (1) month deposit shall answer
partially for damages and any other obligations, for utilities such as Water,
Electricity, CATV, Telephone, Association Dues or resulting from violation(s) of any
of the provision of this contract.

5. DEFAULT PAYMENT: In case of default by the LESSEE in the payment of

the rent, such as when the checks are dishonored, the LESSOR at its option may
terminate this contract and ejectthe LESSEE. The LESSOR has the right to padlock
the premises when the LESSEE is in default of payment for One (1) month and may
forfeit whatever rental deposit or advances have been given by the LESSEE.

6. SUB-LEASE: The LESSEE shall not directly or indirectly sublet, allow or

permit the leased premises to be occupied in whole or in part by any person, form or
corporation, neither shall the LESSEE assign its rights hereunder to any other
person or entity and no right of interest thereto or therein shall be conferred on or
vested in anyone by the LESSEE without the LESSOR'S written approval.

7. PUBLIC UTILITIES: The LESSEE shall pay for its telephone, electric, cable
TV, water, Internet, association dues and other public services and utilities during
the duration of the lease.

8. FORCE MAJEURE: If whole or any part of the leased premises shall be

destroyed or damaged by fire, flood, lightning, typhoon, earthquake, storm, riot or
any other unforeseen disabling cause of acts of God, as to render the leased
premises during the term substantially unfit for use and occupation of the LESSEE,
then this lease contract may be terminated without compensation by the LESSOR or
by the LESSEE by notice in writing to the other.

9. LESSOR'S RIGHT OF ENTRY: The LESSOR or its authorized agent shall

after giving due notice to the LESSEE shall have the right to enter the premises in
the presence of the LESSEE or its representative at any reasonable hour to examine
the same or make repairs therein or for the operation and maintenance of the
building or to exhibit the leased premises to prospective LESSEE, or for any other
lawful purposes which it may deem necessary.

10. EXPIRATION OF LEASE: At the expiration of the term of this lease or

cancellation thereof, as herein provided, the LESSEE will promptly deliver to the
LESSOR the leased premises with all corresponding keys and in as good and tenable
condition as the same is now, ordinary wear and tear expected devoid of all
occupants, movable furniture, articles and effects of any kind. Non-compliance with
the terms of this clause by the LESSEE will give the LESSOR the right, at the latter's
option, to refuse to accept the delivery of the premises and compel the LESSEE to
pay rent therefrom at the same rate plus Twenty Five (25) % thereof as penalty until
the LESSEE shall have complied with the terms hereof. The same penalty shall be
imposed in case the LESSEE fails to leave the premises after the expiration of this
Contract of Lease or termination for any reason whatsoever.

11. JUDICIAL RELIEF: Should any one of the parties herein be compelled to
seek judicial relief against the other, the losing party shall pay an amount of One
Hundred (100) % of the amount clamed in the complaint as attorney's fees which
shall in no case be less than P50,000.00 pesos in addition to other cost and
damages which the said party may be entitled to under the law.

12. This CONTRACT OF LEASE shall be valid and binding between the parties,
their successors-in-interest and assigns.

IN WITNESS WHEREOF, parties herein affixed their signatures on the date

and place above written.
 (Name of Lessor) (Name of Lessee)
LESSOR LESSEE

Signed in the presence of:

_____________________________ ______________________________

ACKNOWLEDGEMENT
Republic of the Philippines)
_________________________) S.S

BEFORE ME, personally appeared:

Name CTC Number Date/Place Issued

(Name of Lessor) 10000000 February 24, 20__ /

Cavite City
(Name of Lessee) 10000000 January 07, 20__ / Makati

Known to me and to me known to be the same persons who executed the

foregoing instrument and acknowledged to me that the same is their free and
voluntary act and deed.

This instrument consisting of ____ page/s, including the page on which this
acknowledgement is written, has been signed on each and every page thereof by the
concerned parties and their witnesses, and and sealed with my notarial seal.

WITNESS MY HAND AND SEAL, on the date and place first above written.

Notary Public

Doc. No.______;
Page No. ______;
Book No.______;
Series of 20___.
Republic of the Philippines )
City of Manila ) S.S.

AFFIDAVIT OF LOSS
I, DENISE ALYSSA PEREZ KATON, of legal age, Filipino citizen and presently
residing at 930 C san Diego, Espana, Manila after been duly sworn to in accordance
with law, hereby depose and say:
That I am a holder of a Republic of the Philippines Social Security System (SSS)
ID issued by the said company.
That on August 24, 2017, yesterday, I was inside a public transport (Jeepney)
going home at San Diego, Espana. I discovered that my wallet was not in the back
pocket of my pants as I need to pay for my fare.
That my SSS Id was also there on my lost wallet.
That diligent effort to locate the same had proved futile;
That I am executing this affidavit to attest to the truth of the foregoing facts and
to request for a replacement of the said SSS ID card from the Republic of the
Philippines Social Security System.
IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of
____ 2017.

DENISE ALYSSA PEREZ KATON

Affiant

SUBSCRIBED and SWORN to before me this _________, 2017, affiant

exhibiting to me his ______________________.

(Sgd.) _______________
Notary Public
Until
______________
PTR No.
_______________
Issued at
______________
On
_______________
Doc. No.
Page No.
Book No.
Series of 2017
GENERAL POWER OF ATTORNEY

KNOW ALL MEN THESE PRESENTS:

I, (Name of Principal), of legal age, single/married to (Name of spouse if any),

Filipino, a resident of (Address), do hereby name, constitute, and appoint (Name of
Agent /Attorney-In-Fact), to be my true and lawful attorney, for me and in my name,
place, and stead, to do and perform the following acts and things to wit:

To ask, demand, collect any and all sums of money, sue to recover debts, dues,
accounts, dividends, legacies, bequests, interests , and other things of value of
whatever nature or kind as may now be or may hereafter become due owing, payable
or belonging to me, and to have, sue, and to take any all lawful ways and means for
the recovery thereof by suit, attachment, compromise or otherwise;

To make, sign, execute, and deliver contracts, agreements, documents and other
writings of whatever nature or kind, with any and all third persons, entities or
concerns, upon terms and conditions acceptable to my said attorney;

To delegate in whole or in part any all of the powers herein granted or conferred,
by means of an instrument in writing, favor of any third persons whom my said
attorney may select;

HEREBY GIVING AND GRANTING unto my said attorney full power and
authority whatsoever requisite or necessary or proper to be done in and about the
premises as fully to all intents and purposes as I might and could lawfully do if
personally present, with power of substitution and revocation, and hereby, ratifying
and confirming all that my said attorney or his substitute shall lawfully do or cause
to be done under and by virtue of these presents.

IN WITNESS WHEREOF, We have hereunto affixed our signatures this

___________ day of ____________________ , 20__ in ______________________, Philippines.

___________________________________ __________________________________
(Principal) (Agent /Attorney-In-Fact)

Signed in the presence of:

_____________________________ ______________________________

ACKNOWLEDGEMENT

Republic of the Philippines)

) S.S

BEFORE ME, personally appeared:

 Name CTC Number Date/Place
Issued

(Name of Principal) 10000000 February 24, 20__ /

Paranaque City
(Name of Agent) 10000000 January 28, 20__ /
Mandaluyong City

Known to me and to me known to be the same persons who executed the foregoing
instrument and acknowledged to me that the same is their free and voluntary act
and deed.

WITNESS MY HAND AND SEAL, on the date and place first above written.

Notary
Public

Doc. No.______;
Page No. ______;
Book No.______;
Series of 20___.
 SPECIAL POWER OF ATTORNEY

KNOW ALL MEN BY THESE PRESENTS:

WE, (Insert Name of Principal) single/married (insert name of spouse if married), of

legal age, with residence and postal address at (Address) do hereby APPOINT
(Insert name of Agent /Attorney-In-Fact)) single/married (insert name of spouse if
married), likewise of legal age, with postal address at (Address) as our true and legal
representative to act for and in our name and stead and to perform the following acts:

To sell, offer for sale, and come to an agreement as to the purchase price
and thereafter to sign for us and in our name and receive payment from the
sale of our property more particularly described as follows:
(Insert Description of Property)

HEREBY GRANTING unto our representative full power and authority to execute
and perform every act necessary to render effective the power to sell the foregoing
properties, as though we ourselves, have so performed it, and HEREBY
APPROVING ALL that he may do by virtue hereof with full right of substitution of
his person and revocation of this instrument.

IN WITNESS WHEREOF , WE HAVE HEREUNTO SET OUR HANDS THIS ____ DAY
OF _______________ 20__, AT (Insert Place of execution of this Instrument).

_______________________________ __________________________________
(Name of Principal) (Name of Agent /Attorney-In-Fact)

Signed in the presence of:

_____________________________ ___________________________________

Republic of the Philippines )

_________________________) S.S

BEFORE ME, personally appeared:

Name CTC Number Date/Place Issued

(Name of Principal) 10000000 Jan 09, 20__ /

Angeles City
(Name of Agent) 10000000 Jan 16, 20__ / City
of Manila

Known to me and to me known to be the same persons who executed the

foregoing instrument and acknowledged to me that the same is their free and
voluntary act and deed.

WITNESS MY HAND AND SEAL, on the date and place first above written.

Notary Public

Doc. No.______;
Page No. ______;
Book No.______;
Series of 20___.