_____________________ ______________________

Witness Witness

“Thumb or Other Mark affixed by _______________ in the presence of

the two (2) disinterested witnesses _____________ and __________________
and the undersigned notary public.”

SUBSCRIBED AND SWORN TO before me this ____________in

_____________, Philippines, affiant exhibiting to me his competent evidence
of identity by way of ________________ which issued on ________________.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.