REPUBLIC OF THE PHILIPPINES )

QUEZON CITY )S.S.

I, __________, _______________, with office address

_____________________, after being sworn to, depose and state:

1. I am connected with the _______________;

2. I have read and understood the contents of Office Order

No. 012, Series of 2021;

3. In compliance with the directive therein for all lawyers to

submit their permanent cellular phone/mobile numbers and other
electronic addresses to the Human Resource Management and
Development Division, I am submitting my details as follows:

Cellphone Number: ______________

E-mail Address: __________________

4. I am freely and voluntarily executing this affidavit to

attest to the truth of the foregoing facts and for whatever legal
purpose this may serve.

IN WITNESS WHEREOF, I have hereunto signed my signature

this _________________ in Quezon City, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this 27th day of

January 2021, at Quezon City, Philippines, affiant having exhibited
his ____________________ and Valid until _____________.

__________________
NOTARY PUBLIC