JURAT

REPUBLIC OF THE PHILIPPINES )

CITY OF ____________ ) S.S.

SUBSCRIBED AND SWORN to before me in the City of ________ this

___ day of ______________ 2022, affiant exhibiting to me his government
issued ID, with details as follows:

Name Competent Evidence of Place/Date of

Identity Issue
XXX XXX

Doc. No. ____

Page No. ____
Book No. ____
Series of 2022.