Republic of the Philippines)

City of Ozamiz )s.s

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

AFFIDAVIT OF GROSS CAPITAL

I, CLARGINA E CONOL of legal age, married , Filipino and a resident of Burgos St. Tinago
Ozamiz City, after having been duly sworn to in accordance with law, do hereby depose and say
that:

1. I am the same person executing this affidavit;

2. My Gross Capital for the year is around Two thousand five hundred (2,500) pesos only;

3. The said wage is so meager and only enough to cover my family’s needs;

4. I am executing this affidavit to attest to the truth of the foregoing facts and for whatever
legal purpose this may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________________, at

Ozamiz City, Philippines.

CLARGINA E. CONOL
Affiant

SUBSCRIBED AND SWORN TO before me this _____________________, at Ozamiz City,

Philippines.