CERTIFICATION

I, __________________________________, Filipino citizen, of legal age,

married to __________________________________, and a resident of
_____________________________________________, hereby depose and say:

That pursuant to the guidelines set forth by the Civil Service Commission in the
filling out of the Statement of Assets, Liabilities and Networth (SALN) form, I
must cause my husband/wife to sign my SALN.

That I am executing this instrument for and in behalf of

my non-compliance to let my husband/wife affix his/her signature in my
SALN considering that he/she is at Davao City.
considering that we have no communication for fourteen (14) years.

Issued on 10th March 2023 at __________, Philippines.

____________________
Declarant