Republic of the Philippines

City of Davao........................SS
x...................................................x

AFFIDAVIT OF CHANGE

I, , of legal age, a Filipino citizen, and with home

address at , after
having been duly sworn in accordance with law, hereby depose and state that:

1. I am the of with
principal office address at , Philippines;

2. In connection with my application for the RENEWAL of my BOC accreditation as

Importer, I hereby confirm that there are material changes in the circumstances
with my company as well as on the documents earlier submitted as follows:

3. In view of the foregoing, I have attached documentary proof in support of

aforementioned material changes;

4. I am executing this Affidavit to attest the truth and for whatever legal purpose it
may serve.

IN WITNESS HEREOF, I have hereunto affix my signature this day of

2021 at Davao City, Philippines.

Affiant

SUBSCRIBED AND SWORN to me before this ____ day of 2021 at Davao

City, Philippines, under penalty of law to the whole truth of the contents of this affidavit.
Affiant personally appeared before me and executed this instrument, and declared to me
that this affidavit is her free and voluntary act and deed.

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