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REPUBLIC OF THE PHILIPPINES)

PROVINCE OF LANAO DEL SUR ) S.S


MUNICIPALITY OF WAO )

AFFIDAVIT

I, TERESITA H. BANCUYO, 63 years of age, Filipino, widow,


and a resident of Barangay Eastern, Wao, Lanao del Sur after
having been duly sworn to in accordance with law do hereby depose
and say;

1. That I was born on December 22, 1954 at Dumalag, Capiz;

2. That the fact of my birth was not registered in any Local


Civil Registry;

3. That I will be sixty four (64) years old this coming


December 22, 2018;

4. That I am executing this affidavit in support with my


application to be a Senior Citizen Pensioner/Grantee.

IN WITNESS WHEREOF, I have hereunto set my hand this 12 th


day of February, 2018 at Wao, Lanao del Sur, Philippines.

TERESITA H. BANCUYO
Affiant

SUBSCRIBED AND SWORN to before me this 12 th day of


February, 2018 at Wao, Lanao del Sur, Philippines. Affiant having
exhibited to me her Voter’s ID with No. 3630-0009A-
L2254THB20000, and who signed this affidavit in my presence and
sworn as to said document that she understood the contents thereof
and that the same is her free act and deed.

DOC. NO._____
PAGE NO.____
BOOK NO.____
SERIES OF 2018