REPUBLIC OF THE PHILIPPINES )

______________________ ) S. S.
______________________ )

AFFIDAVIT

I, ______________________ with address at 210 Calachuchi St., Ayala Alabang

Village, Muntinlupa City______________________ Represented by
______________________ after being duly sworn to in accordance with law hereby
depose and say:

1. That I am the Representative of ______________________ located at 210

______________________;

2. That the previous Engineers of the said construction were:

a. ______________________;
b. ______________________; and
c. ______________________;

3. That due to ______________________, they were replaced by;

a. ______________________;
b. ______________________; and
c. ______________________;

That I am executing this affidavit to attest to the veracity of the foregoing facts and
for whatever legal purposes/ intents it may serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I am affixing my signature this

______________________at ______________________.

______________________
Represented by:

______________________

SUBSCRIBED AND SWORN to before me in the date and place above-

mentioned. Affiant exhibited to me his/her Competent Evidence of Identity above-
mentioned.

Notary Public

Doc. No. ____;

Page: _______;
Book No. ___;
Series of 2019.