Form No.

4--Secretary's Affidavit (Secretary's Affidavit)

Republic of the Philippines)
Province of ____________________)S.S.
City/Municipality of _____________)
x---------------x
AF FI D AV I T
I, _____________, Filipino, of legal age, (single / married / widow), and a resident of
_____________, Philippines, after being sworn to in accordance with law, depose and state:
1.That I am the duly elected Corporate Secretary of __Name of Corporation__, INC.;
2.That the said corporation is filing an application to increase its authorized capital stock from
__________________________ (p___________) to __________________________
(p___________) - common shares and that in connection with the aforesaid application for the
increase of its authorized capital stock, a written waiver of the non-subscribing stockholder(s) is
required;
3.That several of the non-subscribing stockholders have executed written waivers expressly
waiving their pre-emptive rights to subscribe to the increase in the authorized capital stock;
4.That as to the other non-subscribing stockholders, NOTICES were sent to their last known
address informing them of their pre-emptive rights to subscribe to the increase in the authorized
capital stock in proportion to their stockholdings and were given ten (10) days from receipt of the
NOTICE within which to exercise their right to subscribe to the increase;
5.That despite due notice, however, the other non-subscribing stockholders did not or failed to
exercise their pre-emptive rights within the period given and as such are deemed to have waived
their rights to subscribe to the increase in the authorized capital stock;
6.That I am executing this Affidavit to attest to the veracity of the above-mentioned facts and for
the purpose of requesting this Honorable Board/Commission to process the application for the
increase in the authorized capital stock of the corporation.
IN WITNESS HEREOF, I have hereunto set my hand this _____________ in the
_____________, Philippines.
corporate secretary
(JURAT)