REPUBLIC OF THE PHILIPPINES)

CITY OF )S.S.

AFFIDAVIT

I, __________________________________, of legal age and a resident of

_________________________________, do hereby attest to the authenticity of the foregoing:

1. That I am the owner/proprietor of ______________________________;

2. That I have conducted business with the Philippine Coast Guard, particularly
with ______________________________________________, located at
___________________________________________________;

3. That it has come to my attention that my signature in some Purchase Orders

(POs) I have executed with CGDNCR is being questioned by the
Commission on Audit (COA);

4. That, in view of the foregoing, I reviewed the documents in the subject POs
namely: ______________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
___________________________; and

5. That, I hereby attest that said documents were signed by me;

6. That, the varying strokes in my signature may have been brought about by
unavoidable circumstances such as fatigue due to load of documents being
signed at one time and signing while onboard a moving a vehicle, to name a
few.

IN TRUTH WHEREOF, I have hereunto signed my name below this ___ day of
______________ 2020 at _______________________________________________.

_____________________________________
Affiant

SUBSCRIBED AND SWORN TO before me this _____ day of ______________ 20__ at

___________________________.