REPUBLIC OF THE PHILIPPINES )
CITY/MUNICIPALITY OF _______ ) S.S.
)
AFFIDAVIT
I, ______________________, of legal age, Filipino,
single/married, and a resident of __________________________,
after having been duly sworn to in accordance with law, do hereby
depose and state:
1. That ...
2. That ...
3. That ...
IN WITNESS WHEREOF, I have hereunto set my hand this __ day of
__________, 20___ at __________, Philippines.
________________________
(Affiant)
JURAT
SUBSCRIBED AND SWORN TO before me this __ day of __________ 20__,
at __________, affiant exhibited to me his/her
_________________________ (Competent Evidence of Identity) issued
on ________ at ________.
Doc. No. ____;
Page No. ____;
Book No. ____;
Series of 20__.
________________________
NOTARY PUBLIC
(Signature and Seal)
Name of Notary Public
Notarial Commission No. ____
Until December 31, 20__
PTR No. ____________/Date/Place
Roll of Attorneys No. __________
IBP Lifetime No./OR No. _______