Republic of the Philippines}

Province of Zamboanga del Sur} S. S.

Municipality of Molave}

AFFIDAVIT

I, ___________________, of legal age, Filipino citizen, single, and a resident of Barangay

Rufino Lumapas, Bonifacio, Misamis Occidental, Philippines, after having been duly sworn to in
accordance with law, hereby depose and say, THAT:

1. I am the elected __________________________________, elected on October 25, 2010

until November 30, 2013;

2. I was not employed in the government during my term of office as SK Chairman, and I
did not receive any form of salary/compensation, except honorarium for holding a
position in an ex-officio capacity;

3. I am executing this affidavit to prove the veracity of the facts mentioned herein and for
whatever legal intent and purposes this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 8 th day of May 2017 in
Molave, Zamboanga del Sur, Philippines.

_______________________
Affiant

SUBSCRIBED AND SWORN to before me this 8th day of May 2017 in Molave,
Zamboanga del Sur, Philippines.

Doc. No.: 339;

Page No.: 68;
Book No.:XII;
Series of 2017.