REPUBLIC OF THE PHILIPPINES)

) S.S.

AFFIDAVIT

I, ________________________, Filipino, of legal age and a resident of

___________________________, after having been duly sworn in accordance with law, hereby depose
and say that:

1. I am the recipient of a parcel sent by my mother, ___________________, who is an OFW and

currently residing at ____________________;

2. The said parcel was sent thru DHL Express Corporation under Waybill No. ______________ and
contains the following items:
a. two (2) Prada bags
b. one (1) Moschino bag
c. one (1) Lancaster bag
d. one (1) Michael Kors bag
e. two (2) Prada wallets
f. one (1) Prada shirt
g. assorted chocolates

3. The foregoing items contained in the parcel are purely for personal use.

4. I am executing this affidavit to attest to the foregoing facts and to prove that the contents of the
parcel are purely for personal use for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereto set my hand this _____th day of _______________ at
_____________________.

__________________________________
Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public, this ______ day of
___________________ 2017 at ________________________________, affiant exhibited to me her
________________________________ issued at ______________ on _______________.

Doc No.______;
Page No._____;
Book No._____;
Series of 2017.