AFFIDAVIT OF LOT OWNER’S CONSENT

KNOWN ALL MEN BY THESE PRESENTS:

I, _______________________________, single/married, Filipino, a legal age, and a resident

of ___________________________________, hereby depose and state, that:

This is to CONFIRM and ACKNOWLEDGED the amount of_______________________________

(_______) Pesos from______________________ that I have allowed the erection of
pole/s on my property located in Sitio/Zone ______________________ Brgy.
City/Municipality of ,Philippines.

I am completely aware that the said poles will be utilized for FOC Laying under PLDT
FIBERGEN Expansion Project.

Confirmed by: Noted by:

__________________________________
Lot Owner / Authorized Representative
(Signature over Printer Name)
Contact No: ________________________
Date: _____________________________
________________________________
ROW Engineer
________________________________
Authorized Subcontractor of PLDT/ZTE Phils Inc.

SITE NO: ________________

POLE NO. COORDINATES (LAT/LON)