REPUBLIC OF THE PHILIPPINES )

CITY OF MAKATI ) S.S.

AFFIDAVIT OF ECONOMIC STATUS

(GREEN CARD)

I, _______(name)______, Filipino citizen, married, of legal age,

and residing at _____________________(address)_____________ after
having been duly sworn to in accordance with law do hereby
deposes and states that;

1. I am applying for Green Card at Makati Medical Center,

Makati City, and in connection therewith, I am required to
submit a sworn statement of my economic status, hence this
affidavit;

2. I would like to state under oath that I work as a ________(job

title)____________ and receives an average of _________(salary or
fee)__________ and dependent for subsistence and support
upon ________(name of person who supports your daily
needs)____________ who is an Employee, earning
______(salary)___________ a month;

3. I am executing this affidavit to attest to the truth of the

foregoing facts and in order to inform the proper authorities
concerned for all legal intents and purposes this may serve.

AND FURTHER AFFIANT SAYETH NAUGHT.

_______________________
Affiant

SUBSCRIBED AND SWORN to before me this

___________________________ at Makati City, affiant exhibiting to me
his Professional Driver’s License ID No._______________________.

Doc. No. ________

Page No. ________
Book No. ________
Series of 201_