REPUBLIC OF THE PHILIPPINES

)
CITY AND PROVINCE OF ILOILO
) S.S.
x-------------------------------x
AFFIDAVIT
I, LORITO of legal age, single, Filipino and a resident, Philippines after
having been duly sworn to in accordance with law do hereby depose and say
that:
1. That I am a farm worker of _________________________________, the
defendants on the case entitled _______________________________ 573
and is now pending at the MCTC;
2. That I have been a farm worker of said defendant for almost 15 years
and I would help them till a parcel of land, to which they are tenant,
known as Lot no. 2203-A with an area of more or less 10,000 sq. m.;
3. That part of my job as a farm worker is to occasionally pay the rentals
for the said land to either ____________________________ and their other
sibling known to me as ________;
4. That as the payment for the said rentals I would deliver to the house of
_________________________ sacks of palay and/or cash depending on the
mode of payment wanted by _____________
5. That said_________________will not issue me any acknowledgement
receipt upon my delivery;
6. ;
That I am executing this affidavit to attest to the truth of the foregoing
and in support with the in the aforementioned civil case filed against them or
for whatever legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this_____day of
_____2016 at Iloilo City, Philippines.

Affiant
The affiant whose name and personal circumstances are stated above,
personally known to me and personally appeared before me this ______ day of
_____________2016, in the City of Iloilo, Philippines, presented the foregoing
affidavit, signed the same in my presence and affirmed under oath to the
correctness of the contents or allegations of the same.
The Affiant was identified by competent evidence of identity namely
his _____________________ to establish his identity.
Doc. No. ____;

Page No. ____;

Book No. _____;
Series of 2016.