(Jurat for Joint Affiants)

SUBSCRIBED AND SWORN to before me, this _____________, by

_____________ who exhibited to me (his/her) Community Tax Certificate
No. _____________ issued at _____________ on _____________ and by
_____________ who exhibited to me (his/her) Community Tax Certificate
No. _____________ issued at _____________ on _____________.

Notary Public

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______;