EPUBLIC OF THE PHILIPPINES)

City of ) S.S.
x-----------------------x

AFFIDAVIT OF INCOME
I, Romeo I. Lim Filipino, of legal age, married, and with business address at
26 M. Valte St. Barangay Libis, San Rafael, Bulacan, Philippines, after being duly
sworn in accordance with law, depose and state:

1. That I am the business owner of Anmari’s Fashion House with

BIR TIN 144-620-566-001 and existing under and by virtue of
the laws of the Republic of the Philippines;

2. That I am a bona fide member of PhilHealth with member no.

190518187701.

3. That I am a self employed and earning a monthly Income of PHP

20,000.00

4. As such, I am executing this Affidavit of Income to attest to the

truth of the foregoing and for whatever legal purposes that this
may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ______day of

_____ 2023 at ______________, Philippines.

ROMEO I. LIM
AFFIANT

SUBSCRIBED AND SWORN to before me, this ____ day of _____ by the Affiant
who whom I have identified through competent evidence of identity and who exhibited
her _______________________ issued at _____________ on ____________.

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 2023.