Professional Documents
Culture Documents
: QWP-CDRRHR/RRD-01-Annex 4
Revision: 02
ROMEO G. MONTAÑER, MD
I, ___________________________________, of legal age, single/married, and a resident
YAPSEA ST., HAPPY HOMES SUBD., COTABATO CITY
of __________________________________________________________, after having been
duly sworn to in accordance with law hereby voluntarily depose and state:
24TH
IN TRUTH WHEREOF, I have hereunto signed my name below, this _____day
OCTOBER 9 at________________________.
of_______________201___ MALABANG, LANAO DEL SUR
SUBSCRIBED AND SWORN to before me, this ___ day of______________ 201___
in_______________________________________, affiant exhibiting his/her Community tax
Certificate No.__________ issued at ____________________ on____________________.
__________________________
Notary Public
Doc No._______
Page No.______
Book No.______
Series of 201___