REPUBLIC OF THE PHILIPPINES)

PROVINCE OF TARLAC ) S.S.

x----------------------------------x

AFFIDAVIT

I, ___________________, of legal age, married, Filipino, resident of, Tarlac,

and after having been duly sworn to in accordance with law, depose and say:

1. That I was born in, Tarlac on September 1, 1961 from parents Serapio
and Dolores;

2. That I personally know JEFFREY because we had lived in the same

locality for a long time, and her family has been a close family friend;

3. That JEFFREY was born on October 5, 1983 at Tarlac City, Tarlac from
parents Joel and Susana;

4. That I know that ____________________ because his father is my best

friend and we were neighbor since he was born;

5. That as such, I execute this Affidavit to attest to the truth of the

foregoing facts and for any other legal purpose that this Affidavit may
serve.

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

_______________________, at ________________, Philippines.

_________________________
Affiant

SUBSCRIBED AND SWORN TO before me this _____ day of

_________________________, at ________________, Philippines.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2020.