Republic of the Philippines In the City of Davao . . .

) ) S.S

I, _____________, Filipino, of legal age and resident of ________________, Davao City, upon y oath do hereby depose and say, that!

". #hat I a not gainfully e ployed and thus, I only generate enough for e and y fa ily$s sustenance%

ini al inco e

&. #hat I a not currently e ployed 'ith any person, natural or (uridical, and I have not been gainfully e ployed. ). *y husband ____________________ is presently ___________________ and is earning ini u 'age% connected 'ith

+. I e,ecute this affidavit to attest to the truth of the foregoing and for 'hatever legal purpose this ay serve. IN WITNESS WHEREOF, I hereunto set Davao City, Philippines. y hand this _______________ in

__________________ -ffiant

SUBSCRIBED AND SWORN to before e this _________________ in the City of Davao, Philippines, affiant e,hibiting to e her Co petent .vidence of Identity in the for of her SSS ID /o. _______________ issued in Davao City, Philippines. Doc. /o. ______% Page /o. ______% 0oo1 /o. ______% Series of &2"&.

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