REPUBLIC OF THE PHILIPPINES)
_____________________ ) SS.
AFFIDAVIT
I, ________________________, of legal age, ____________, and
with address at ___________________________, under oath, state:
THAT I __________________________;
xxxxxx
xxxxxx
4. THAT I am
executing this Affidavit to attest to the truth of the foregoing facts and to
use the same for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I hereunto affix my signature this
_________________ at ________________________.
_____________________
Affiant
SUBSCRIBED AND SWORN to before me this _______________ at
_______________, Affiant exhibiting to me his/her Postal ID _____________
issued at ______________ on _________________.
(Sgd)--------------------------
Notary Public for ---------------------
Commission Serial No: 1234
Until December 31, 2015
(office address)
Roll No: 12345
IBP Lifetime Roll No:
12345:5/6/2010: (province)
PTR No: 12345: 5/6/2010: (province)
MCLE Compliance Cert. No:
12345: 5/6/2010
Doc No. ________;
Page No. _______ ;
Book No. _______;
Series of ________.
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