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Republic of the Philippines

)

City of _______________ )S.S.

SWORN AFFIDAVIT

That I, __________________________, married, and of legal age, own and
manage _______________________________, a duly registered and licensed
_____________________________________, with office address located at ________

________________________________, and after being duly sworn to law, depose and
say:

1. That the firm stated above has not been operating under a different name
other than what has been duly registered with the Department of Trade and Industry
and duly licensed to operate in _______________ by the City Mayor’s Office;

2. That the said firm has not been charged with any labor case in the Department
of Labor and Employment and in the National Labor and Reconciliation Commission,
nor having pending cases with the same;

3. That the said firm has not been operating with a Trade Name that has a
cancelled registration with the Department of Trade and Industry;

That I am further executing this affidavit to affirm the truth of my foregoing
statements and for whatever legal purpose it may serve me best.

IN WITNESS WHEREOF, affixed my signature this ___ day of _________ 2012
at ______________________________

_____________________
Affiant

SUBSCRIBED AND SWORN to before me this ____ day of ____________2012
affiant presented to me his/her Community Tax Certificate # ________________
issued on ______________ issued at _________________.

Known to me and known to be the same person who executed the foregoing
affidavit.

Book No. __________
Doc. No.__________
Page No. _________
Series of 2012______