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Republic of the Philippines))

Municipality of Silang, Cavite)s.s


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

SUBSCRIBED AND SWORN to before me this ___ day of November in the year 20__
at _________, affiant having exhibited to me her passport with number P2871___ issued on
August 1, 2019 and valid until August 1, 2029 at Manila, Philippines.

Doc. No.: _______________________


Page No.: _______________________
Book No.: _______________________
Series of: _______________________

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