AFFIDAVIT

I, _____________________________________________________________________, a Philippine citizen, of

legal age, single / married, and with present address in France / Monaco at
_________________________________________________________________________________________,
after having been sworn to in accordance with law, do hereby depose and say, that:
1. ___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________;
2. ___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________;
3. ___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________;
4. ___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________;
5. ___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________;
6. ___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________;
7. I am executing this Affidavit to attest to the truth, to the best of my knowledge, and for whatever legal
purpose and intent it may serve.
IN WITNESS WHEREOF, I hereby sign this Affidavit on ____________________________ in
________________________.

___________________________________________
Printed Name and Signature