epublic of the Philippines )

City of ________________ ) S.S.

x-----------------------------------------------x

AFFIDAVIT OF NO RENTAL

I, __________________________, of legal age, single/married, Filipino, and a

resident of ___________________________________, Philippines, after having been
duly sworn in accordance with law, hereby depose and state:

1. That as a practicing doctor I am holding clinic in ______________________;

2. That I am just sharing the said clinic space with another doctor, Dr. ________________,
who is the contracting party as lessee in the Contract of Lease entered into between
him and the building owner/lessor;

3. That in view of the lessee’s generous accommodation, I am not paying any rental fee to
the building owner, subject to my agreement with the lessee that I will share the cost in
covering clinic overhead expenses;

4. That this arrangement is consented to by the building owner/lessor;

5. That I am executing this affidavit to declare the truth of the foregoing facts and for
whatever legal purpose it may serve.
 IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at
_____________________, Philippines.

_________________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this ______ day of _______________ in the City
of _______________, Philippines, by ___________________, who is personally known to me and who
presented his _____ ID No. ________________ which expires on _______________, and who is the
same person who personally signed before me the foregoing affidavit and acknowledged that he
executed the same.

Doc. No. _____;

Page No. _____;

Book No. _____;

Series of 2015.