Republic of the Philippines)

) s.s.
City of Makati )

AFFIDAVIT

I, _____________, of legal age, single and with postal address at

_______________ after having being duly sworn in accordance with law do
hereby depose and say: That-

1.

2.

3.

4. I am executing this affidavit in order to attest to the truth of all the

foregoing facts and circumstances and for all other legal intents and purposes.

IN WITNESS WHEREOF, I have here unto set my hand this __day of

________ 2010 at the City of Makati.

AFFIANT

SUBSCRIBE AND SWORN to before me this __ day of ________ 2010 at

the City of Makati, Affiant exhibited to me his/her_________________________
issued on______________ at _________________.

NOTARY PUBLIC

Doc___;
Page___:
Book __;
Series of 2010.