REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA )S.S.

AFFIDAVIT OF NON-EMPLOYMENT

I, ____________ , of legal age, married, Filipino with residence and postal

address at _________________Brgy. Bugo Cagayan de Oro City, Misamis Oriental, after
being duly sworn in accordance with law hereby depose and say, that:

By this Affidavit, I attest that am presently unemployed .

That I have no pending administrative and criminal case in any court, tribunal or
administrative bodies.

I am executing this affidavit to attest to the truth of the foregoing and for
whatever legal purpose this may serve, including “For Change of Name and No
Pending Administrative/Criminal case”

“FURTHER, AFFIANT SAYETH NAUGHT.”

IN WITNESSETH WHEREOF, I have hereunto set my hand and affix my

signature on this February 15, 2018 at the City of Manila.

Affiant

SUBSCRIBED AND SWORN TO before me this February 15, 2018 at the City
of Manila, affiant exhibiting her UMID ID No. _____________

Doc. No.
Page no.
Book no.
Series of 2018