REPUBLIC OF THE PHILIPPINES )
MALOLOS CITY, BULACAN . . . . . ) S.S.
AFFIDAVIT OF INCOME/GROSS SALE
I, TEODY C. SAN ANDRES, of legal age, Filipino and resident of 316 Culianin,
Plaridel, Bulacan, after having been duly sworn to in accordance with law, do hereby depose
and say:
1. – That I am the owner/proprietor of TCS Publishing House with business address at
Culianin, Plaridel, Bulacan;
2. – That I started to operate said business since March, 2010 up to present;
3. – That I only earned P203,758.00 in the past year 2010 because the business company
just started a year ago;
4. – That I am executing this affidavit to attest to the veracity of the facts contained
herein and for all legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 6 th day of January 2011 at
Malolos City, Bulacan.
TEODY C. SAN ANDRES
Affiant
Driver’s License No. C07-98-174160
SUBSCRIBED AND SWORN to before me this 6 th day of January, 2011 at Malolos City,
Bulacan.
Doc. No. ___; BERNAR D. FAJARDO
Page No.___; Notary Public
Book No 86; Until December 31, 2012
Series of 2011. P.T.R. No. 4048722
MCLE III 0019636 12-21-10
Roll No. 33633
REPUBLIC OF THE PHILIPPINES )
MALOLOS CITY, BULACAN . . . . . ) S.S.
AFFIDAVIT OF INCOME/GROSS SALE
I, VANESA T. CAPARAS, of legal age, Filipino and resident of Atlag, Malolos City,
Bulacan, after having been duly sworn to in accordance with law, do hereby depose and say:
1. – That I am the owner/proprietress of VANESA CAPARAS SALON located at San
Pablo, Malolos City, Bulacan;
2. – That I started to operate said business since May 2007 up to May, 2008;
3. – That I only earned P60,000.00 from said year of operation;
4. – That I am executing this affidavit to attest to the veracity of the facts contained
herein and for all legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 18 th day of April, 2011 at
Malolos City, Bulacan.
VANESA T. CAPARAS
Affiant
PERSONALLY APPEARED BEFORE ME, a Notary Public for and in the Province of
Bulacan, on this 18th day of April, 2011, VANESA T. CAPARAS who subscribed and sworn to the
foregoing document and who avow under the PENALTY OF LAW to the truth of its contents.
I hereby certify that the affiant has been identified by the undersigned Notary Public
through Competent Evidence of Identity, as follows:
Evidence of Identify : Non-Prof. Driver’s C07-09-012475.
which bear her picture and signature.
WITNESS MY HAND AND SEAL.
Doc. No. 366; BERNAR D. FAJARDO
Page No. 75; Notary Public
Book No. 87; Until December 31, 2012
Series of 2011. P.T.R. No. 4048722
MCLE III-0019636 12-21-10
Roll No. 33633
REPUBLIC OF THE PHILIPPINES )
MALOLOS CITY, BULACAN. . . . . .) S.S.
AFFIDAVIT OF INCOME
I, JOSEFINA M. SARIBA, of legal age, married, Filipino and resident of
Block 26 Lot 19 Mahusay St., Maunlad Homes, Malolos City, Bulacan, after
having been duly sworn to in accordance with law, do hereby depose and say:
1. That I am the guardian/grandmother of DANE AKIZHA ZIANTEL S.
TAYAO, who was born on July 8, 2006 in Malolos City, Bulacan;
2. That the mother of my said granddaughter is JOANA MARI SARIBA
TAYAO;
3. That my daughter Joana Mari Sariba Tayao is presently working in
Macau as an Overseas Contract Worker;
4. That I know that she derive a monthly income of 3,500 MOP/Pataca
or Twenty Two Thousand Pesos (P22,000.00) Philippine Currency;
5. That I am executing this affidavit to attest to the veracity of the facts
contained herein and for whatever legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this __ day of
____________, 2018 at Malolos City, Bulacan.
JOSEFINA M. SARIBA
Affiant
SUBSCRIBED AND SWORN to before me this ___ day of ________, 2018
at Malolos City, Bulacan. affiant exhibiting to me her ID No. _________, a
competent proof of identity, and known to me and to me known personally to
be the same person who executed the foregoing Affidavit.
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2018.
REPUBLIC OF THE PHILIPPINES )
MALOLOS CITY, BULACAN. . . .) S.S.
AFFIDAVIT OF NO INCOME
I, EFREN S. DOMINGO, of legal age, married, Filipino and resident of Tabe,
Guiguinto, Bulacan, after having been duly sworn to in accordance with law, do hereby depose
and say:
That I am a member of Social Security System with SSS No. 03-4257701-3 and as such
I am voluntary paying my monthly contribution;
That since April, 2012 up to present, I have no means of income;
That I am no longer engaged in any profitable employment nor I am not engaged in any
business from when I will derive my income;
That I am executing this affidavit to attest to the veracity of the facts contained herein and
for whatever legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 15 th day of February, 2013
at Malolos City, Bulacan.
EFREN S. DOMINGO
Affiant
SUBSCRIBED AND SWORN to before me this 15 th day of February, 2013 at Malolos
City, Bulacan. affiant exhibiting to me his SSS ID No. 03-4257701-3, a competent proof of
identity, and known to me and to me known personally to be the same person who executed the
foregoing Affidavit.
Doc. No. ___; BERNAR D. FAJARDO
Page No.___; Notary Public
Book No. 98; Until December 31, 2014
Series of 2013. PTR No. 9473699 Roll No. 33633
MCLE IV-0002533 8-16-11
REPUBLIC OF THE PHILIPPINES )
MALOLOS CITY, BULACAN. . . .) S.S.
AFFIDAVIT OF DECLARATION OF INCOME
I, LEONORA S. CRUZ, of legal age, married, Filipino and resident of 0457 A3 P.
Mabini Streety, Barihan, Malolos City, after having been duly sworn to in accordance with law,
do hereby depose and say:
That, I am a member of Philippine Health Insurance Corporation with Philhealth No. 21-
025056824-4, and as such, I am voluntary paying my monthly contribution;
That since April, 2012 up to present, I have no means of income;
That I am not engaged in any profitable employment muchless engaged in any business
from when I will derive my income;
That I am executing this affidavit to attest to the veracity of the facts contained herein and
for whatever legal intents and purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 12 th day of March, 2020 at
Malolos City, Bulacan.
LEONORA S. CRUZ
Affiant
Philhealth ID # 21-025056824-4
SUBSCRIBED AND SWORN to before me this 12 th day of March, 2020 at Malolos
City, Bulacan. affiant exhibiting to me her valid ID listed below her name, a competent proof of
identity, and known to me and to me known personally to be the same person who executed the
foregoing Affidavit.
Doc. No. ____;
Page No.____;
Book No. ____;
Series of 2020
