Republic of the Philippines)

Las Pias City

) s.s.
AFFIDAVIT OF DENIAL OF CONSENT
I, , of legal age, Filipino, married with residence and postal address at
the ty, Philippines, after having been sworn to in accordance with law, do
hereby depose and state that:
1. I am the mother of who is 18 years of age and member of
2. My son would like to purchase his own firearm so that he can
participate in the shooting activities of his gun club;
3. I have not consented and NOT fully authorized my son to purchase
a firearm of his choice to be used in the shooting activities of his gun club;
4. I am executing this affidavit of NO consent to attest to the truth of
the foregoing and for its submission to the Intellectual Property Office.
Done this 16 September 2009 at Las Pias City, Philippines.

Affiant
SUBSCRIBED AND SWORN to before me this _________________, at Las
Pias City Philippines, affiant exhibiting his CTC No. _______________ issued on
_______________ at _______________, Philippines.

Doc. No: ___

Page No: ___
Book No: ___
Series of 2009