REPUBLIC OF THE PHILIPPINES)
_____________________ ) SS.
I, ________________________, of legal age, ____________, and with address at ___________________________, under oath, state:
- THAT I __________________________;
4. 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 ________________________.
SUBSCRIBED AND SWORN to before me this _______________ at _______________, Affiant exhibiting to me his/her Comm. Tax Cert. _____________ issued at ______________ on _________________.
Doc No. ________;
Page No. _______ ;
Book No. _______;
Series of ________.