REPUBLIC OF THE PHILIPPINES }

QUEZON CITY } S.S.

AFFIDAVIT OF ACCEPTANCE

I, Efren R. Renon, Filipino, of legal age, married, and a resident of 115

Maria Clara St., Caloocan City , after having duly sworn to in accordance with
law, hereby depose and say that:

1. That an agreement between the undersigned and Superb Security and

Investigation Agency, Inc. had been made.

2. That I have accepted the amount of SIXTEEN THOUSAND TWO

HUNDRED Pesos (P16,200.00) from SUPERB SECURITY AND
INVESTIGATION AGENCY INC., for the Payment of my monthly Premium
contributions to Philhealth from July 2008 to May 2015;

3. That in my own capacity, I will personally pay my PHILHEALTH monthly

contribution and in return I will give the PHILHEALTH receipts to Superb
Security and Investigation Agency, Inc. as my faithful compliance with the
agreement;

4. That failure to return the said receipts will constrain Superb Security and
Investigation Agency, Inc to file a Legal Action/Complaint against me to
enforce the said Agreement;

5. I am executing this affidavit to attest to the foregoing facts;

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of

June 2016 in Quezon City, Philippines.

Efren Renon
Affiant

SUBSCRIBED AND SWORN to before me this ______ day of _____________

_______ in ____________________ Philippines, affiant having exhibited to
me his/her issued by the Social Security System.

NOTARY PUBLIC

Doc. No.____;
Page No.____;
Book No.____;
Series of 2016.