Republic of the Philippines ) S.s.

City of Tacloban )

AFFIDAVIT

I, _____________________, Filipino, of legal age, single and a resident of Brgy.

_______________________, after being duly sworn to in accordance with law, hereby
depose and state:

1. That I successfully completed ________________, with the

_________________ on _________________ as evidence thereof I have
hereto attached a copy of my Certificate issued by the said academy, dated
January 2020 as Annex “A”;

2. That I am executing this affidavit to attest to the truth of the foregoing statement
and for my application for Authentication of Documents with the Department of
Foreign Affairs, Office of Consular Affairs – Authentication Division.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 20th day of

January, 2020 in Tacloban City, Leyte.

____________________

SUBSCRIBED AND SWORN to before me this day, ____________, in

_______________________, affiant exhibited her identification card indicated above,
bearing her name and signature and swore to me that the above document is her free
and voluntary act and deed.

Witness my hand and seal in the place and date mentioned.

Doc No._____,
Page No._____,
Book No._____,
Series of 2020.