Republic of the Philippines )

Tacloban City ) s.c.

SWORN STATEMENT

I, VVV, Filipino, of legal age, single, and a resident of AAA City, after being sworn
to in accordance with law, hereby depose and say, THAT:

1. I am an applicant for PNP Training at PNP Maritime Group;

2. I am confirming that the following are my legal beneficiaries:

Name Relationship Date of Birth

a. AAA Mother February 1, 1971
b. BBB Father April 1, 1974

3. My relationship with the person whose names listed above are borne by the
fact that I am the lawful son of the above-named persons as evidenced by
my Certificate of Live Birth;

4. I hold myself criminally and administratively liable for perjury and dishonesty
should any statement made herein be found to be false and contrary to law;

5. I am executing this affidavit freely and voluntarily in order to establish the

truth of the foregoing facts for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

____________ at AAA City, Philippines.

VVV
Affiant

SUBSCRIBED AND SWORN to before me this _________________ at AAA City,

Philippines, affiant who exhibited to me his PRC with Registration No. 11111 as
competent proof of his identity.

Doc No.
Page No.
Book No.
Series of 2020.