[For use of clients who do not own any real property r ]

Republic of the Philippines )

Quezon City ) S.S.

AFFIDAVIT

I, ESMERALDO S. BALOSA, of legal age, Filipino and resident of No. 50

Alley 6, Batasan Hills, Quezon City, do hereby state under oath that:

1. I am a Plaintiff in the Petition to Revive Judgment in Balosa v.

Villanueva, Civil Case No. 0-89-2369, Branch 97, Regional Trial Court
of Quezon City to be filed in the Regional Trial Court of Quezon City;

2. The combined total of my monthly gross income and that of the other
members of my immediate family does not exceed an amount of
double the monthly minimum wage of an employee, or FOURTEEN
thousand and FIVE hundred pesos (P14,500.00);

3. I do not own real property;

4. I am executing this affidavit so that I may qualify as an indigent

litigant who may be exempted from the payment of legal fees, as
provided for in A.M. No. 04-2-04-SC dated July 20, 2004, which revised
Rule 141 of the Rules of the Court.

IN WITNESS WHEREOF, I here unto affix my signature this_____ day of

___________________ 2005 at Quezon City, Philippines.

_________________
Affiant

SUBSCRIBED AND SWORN to before me this _____day of _________ 2005.

Affiant having displayed to me his Residence Tax Certificate No.__________
issued at __________________________on _______________________.

Notary Public
My commission expires on

Doc. No._____
Page No._____
Book No._____
Series of 2005