DECLARATION OF ORIGINALITY AND AUTHENTICITY

REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA ) S.S.

I, REPARADO B. GALOS III, Filipino, of legal age, residing at 34 CENTRAL AVE.,

CULIAT, QUEZON CITY, after having been sworn in accordance with law hereby depose
and state:

That I am the true and lawful owner of the poetry collection

entitled: MGA PAGTITIG MULA DALAMPASIGAN;

That each of the documents submitted is authentic and original,

and that all the statements and information provided therein are true
and correct;

That I am executing this affidavit to attest to the truth of the

foregoing and as part of the requirements of Maningning Miclat Poetry
Awards-Year 2015.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of _______________.
20___ at _________________________.

REPARADO B. GALOS III

SUBSCRIBED AND SWORN to before me, this ____ day of ______________, 20___
in ___________________ City, with affiant exhibiting his CTC No. _______________ ,
Issued on ______________________ at _________________________.

NOTARY PUBLIC

Doc. No. : ________;

Page No. : ________;
Book No. : ________;
Series of 20___.