SWORN STATEMENT

I, _, of legal age, with address at _, depose and state under oath:

1. I am the [ ] applicant for registration

[ ] authorized officer of applicant-corporation
[ ] agent/authorized representative of applicant

of the mark _ with Application No.

(no application number yet/ filed simultaneously with the application).

2. The total assets of the applicant do not exceed Php 100 Million.

___________________

SUBSCRIBED AND SWORN TO before me this ______ day of

__________, Affiant who personally appeared before me presenting to me
his Identification which is a ___________________ with number
______________ issued on ________________ at _____________.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2019.