AFFIDAVIT

I, _______________________, Filipino, of legal age, and residing at

____________________________, Republic of the Philippines, do make oath and swear as follows:

1. My name is __________________________;

2. My current address is ____________________________________________;

3. My date of birth is _______________________________;

4. I am a citizen of the Republic of the Philippines;

5. The signature, which appears below, is, for all intents and purposes, my true and correct
signature.

_________________________________
Specimen Signature

6. I hereby swear that the above statement is true and correct in every detail.

IN TRUTH WHEREOF I have hereunto set my hand this _________________ in _________________.

_____________________________
Affiant

SUBSCRIBED AND SWORN to before me this _______________________ in

_______________________ affiant exhibiting to me his/her TIN ______________________.

Doc No. _________;

Page No. ________;
Book No. ________;
Series 2023