REPUBLIC OF THE PHILIPPINES)

CITY OF ROXAS……………………………………)S.S

AFFIDAVIT OF RESIDENCE

I, ________________________________of legal age, Filipino, single/married,

residing at ________________________________, under oath depose and state;

1. I am bonafide resident of __________________________________,

2. I have been a permanent resident of ___________________________, f

or ______ year/s;

3. I am executing this Affidavit under pain of perjury in order to pr

ove my residence as required for my application for the renewal of
tricycle franchise.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _________

__________, at Roxas City, Capiz, Philippines.

______________________________
Affiant

Gov’t ID No.____________________________

SUBSCRIBED AND SWORN TO before me, this _____________________at Roxas City,

Capiz, Philippines.

Doc. No._________;
Page No. ________;
Book No._______;
Series of 2023