Revised March2012

TREASURERS AFFIDAVIT

Republic of the Philippines )

Prov./City/Mun. _________________) S.S.
x--------------------------------------------x

I, __________________________________________ after having been duly

sworn to in accordance with law, do hereby depose and say:

1. That I am the duly elected Treasurer of the

___________________________________________________________________________
to act as such until my successor shall have been appointed and qualified in
accordance with the By-laws of the Federation;

2. That as such, I hereby certify that the authorized share capital of this
cooperative is ___________________________________________ (Php _______ )

3. That the subscribed share capital of the cooperative is

__________________________________________________________ (Php_______)
which is at least twenty five (25%) percent of the authorized capital ;

4. That the paid-up share capital of the cooperative is

________________________________________________________ (Php_______)
which is at least twenty five (25%) percent of the subscribed capital;
and

5. That the total membership fees paid is ______________________

_________________________________ (Php _______________).

6. That I have actually received the total paid-up share capital and
membership fee.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

___________ day of ______________, in ________________, Philippines.

__________________
Affiant

SUBSCRIBED AND SWORN TO before me this ___________ day of

______________, in ________________, Philippines, by _______________________ who
exhibited to me his/her Proof of Identity ___________ issued on ___________________, in
______________________, Philippines.

Notary Public
Doc. No. ________
Page No. ________
Book No. ________
Series of ________

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