Affidavit of Confirmation

REPUBLIC OF THE PHILIPPINES) CITY OF …………………………………..) MUNICIPALITY MUNICIPALITY OF ……………………)

AFFIDAVIT OF CONFIRMATION I, ____ ______ ____ ____ ____ ____ ____ ____ ____ ____ ____ ____ ___, _, Filip ilipin ino, o, of l!" l!"ll "!, "!, #in! #in!l l "n$ "n$ " %#i$n& %#i$n& of _______________ _______________________ ________________ _______________ _______________ ________,, P'ilippin#, P'ilippin#, "f&% '"(in! n $*l+ #o%n in "--o%$"n- i&' l" '%+ "-nol$! &'"&/ 0. T'"& T'"& on _____ _______ _____ _____ _____ _____ _____ _____ _____ ______ _____ _____ ___ , I 1-* 1-*&$ &$ " Sp-i Sp-i"l "l Po% of A&&o%n+ "*&'o%i2in! 3+ A&&o%n+4in4F"-&  _______________  _______________________ _______________ ____________ _____ &o #ll &' folloin! folloin! #&"&$ p%op%&i#/

5. On _____________ _____________________ ________________ ________,, 3+ "&&o%n+4in4f""&&o%n+4in4f"-&& n&%$ n&%$ in&o " Con&%"-& of L"# o(% &' folloin! #&"&$ p%op%&i#.

6. I '%+ '%+ "7%3 "7%3 "n$ "n$ -on8% -on8%3 3 &' &' Co Con&% n&%"-& "-& of L"# L"# n&% n&%$ $ in&o + 3+ A&&o% A&&o%n+ n+4in 4in4F 4F"-& "-& on _____ ________ ______ _____ _____ _____ _____ ____ _ "n$ "n$ 'i-' 'i-' "# "# 1-* 1-*&$ &$ fo% fo%  No&" No&"%+ %+ P*li P*li- _____ _______ _____ _____ _____ _____ _____ _____ _____ ____, _, "n$ "n$ n&%$ n&%$ "# Do-. Do-. No. No. _______ _______99 P"! No. _______9 _______9 Boo No. No. _______ _______99 S%i# of 5:0; of 'i# no&"%i"l %!i#&%.

<. I f*%&'% -on8%3 -on8%3 &'"& I '"( '"( "*&'o%i2$ "*&'o%i2$ &'"& &'"& "ll p"+3n&# p"+3n&# p"+"l p"+"l &o 3 + (i%&* of &' "o(4#&"&$ -on&%"-& of l"#  3"$ p"+"l *n$% *n$% &' n"3 n"3 "n$ "--o*n& "--o*n& of 3+ A&&o% A&&o%n+ n+4in4F 4in4F"-&. "-&. I f*%&'% f*%&'% "*&'o%i2 3+ A&&o%n+4in4F"-& A&&o%n+4in4F"-& &o n-"#' "n$=o% $po#i& #"i$ -'-# in p"+3n& of &' l"# of 3+ p%op%&i#.

IN >ITNESS >HEREOF, I '"( '%*n&o "71$ 3+ #i!n"&*% &'i#  _____ of _______________ ____________________ _____ 5:0;, in &' -i&+=p%o(in- -i&+=p%o(in- of   _______________  _______________________ ________,, P'ilippin#. P'ilippin#.

 ________________  _______________________ ________  _  A7"n&

SUBSCRIB SUBSCRIBED ED AND S>ORN TO BEFORE BEFORE ME, &'i# ________ ________ $"+ of   _______________  ___________________ ____ 5:0;, 5:0;, in &' -i&+=3*ni-ip"li&+ -i&+=3*ni-ip"li&+ of ________________ ________________________ _________, _, P'il P'ilip ipp pin# in#,, "7"n "7"n&& '"(i '"(in! n! p%# p%#n n& &$ $ &o 3 &' &' foll follo oin in! ! ("li ("li$ $ "n$ "n$ "--p&"l p%oof of 'i# i$n&i&+ Do- No. _______9

P"! No. ______9 Boo No. ______9 S%i# of 5:0;.