Republic of the Philippines)

City of Iloilo ) S.S.

x------------------------------------------x

AFFIDAVIT OF DECLARATION

I, SHIRLEY V. ARGAÑOZA, of legal age, Filipino, and a resident

of Block 8, Lot 28, Deca Homes, Pavia Resort Residences 2, Phase 3,
Balabag Pavia, Iloilo, after having duly sworn to in accordance with law,
do hereby depose and say:

1. That I am applying for ILECO 1 membership;

2. That I am married but I am not living together with my
husband for long period of time;
3. That I want to bear my maiden family name, SHIRLEY
FLORES VILLARUZ in my membership and in my billing
statement purposes only;
4. That I am executing this affidavit to attest to the truth of
the above statement to for whatever legal purposes this
affidavit it may serve
IN WITNESS WHEREOF, I have hereunto set my hand this

_______________, at Iloilo City, Philippines.

SHIRLEY V.
ARGAÑOZA
Affiant

SUBSCRIBED AND SWORN to before me this ___________ after

affiant exhibited to me her government issued ID: ______________ as
proof of her competent evidence of identity.

Doc No. ____

Page No. ___
Book No. ____
Series of 2019