REPUBLIC OF THE PHILIPPINES

PARAÑAQUE CITY ) S.S,

AFFIDAVIT

I, _________________ of legal age, Filipino, with business address

______________________________________________________________________, after being duly
sworn, hereby deposed and state:

1. That I am the owner of ________________________________ with business name no.

____________ located at __________________________________________________
__________________________________________.

2. That the company is a legit seller of a brand new and refurbished computer parts and storage.

3. That this affidavit form is part of the requirements of the Optical Media Board (OMB).

I am executing this affidavit to attest to the truth of the foregoing and for other such legal
purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of _____________ 2020 in
Parañaque City.

__________________________

Affiant

SUBSCRIBED AND SWORN to before me, this ____ day of _____________ 2020, Philippines,
affiant personally appeared and showed to me his competent evidence of identity in
______________________.

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