REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAMARINES NORTE )S.S.

MUNICIPALITY OF LABO )
x---------------------------------------------------x

AFFIDAVIT

I, AAAAAAAA, of legal age, Filipino citizen and with residence and postal address
at_____________________, after having been duly sworn to in accordance with law, hereby
depose and say:

1. That I am the daughter of spouses ______________(deceased) and

_______________ having been born on December 13, 1950 and evidenced by a Certificate of
Birth which is hereto attached;

2. That I executed this affidavit in good faith for the information of Department of
Social Welfare and Development office of ______________ in connection with the release of
my mother’s pension from the aforesaid office.

3. That all the statements above are true and correct to the best of my knowledge and
belief.

IN WITNESS WHEREOF, I have hereunto set my hand this 23 rd day of July 2018 at Labo,
Camarines Norte.

_____________________
Affiant

SUBSCRIBED AND SWORN to before me this 23rd day of July 2018 at Labo, Camarines
Norte, affiant exhibited to me her ___________________.

Doc. No._________;
Page No._________;
Book No._________;
Series of 2 0 1 8 .