REPUBLIC OF THE PHILIPPINES )

Quezon City )S.S.

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

AFFIDAVIT OF RESIDENCY

I, _______________________, of legal age, Filipino, single, and residing at

_____________________________________, after having been duly sworn to in accordance
with the law, deposes and states THAT:

1. I was required to submit my latest Barangay Certificate of Residency from my hometown

Brgy. Masaya, Municipality of Bay, Province of Laguna, Philippines, to be used for
taxation purposes in the Netherlands;

2. I was issued a Barangay Certificate of Residency sometime in 2016, copy hereto

attached;

3. Due to the Community Quarantine brought about by the COVID-19 Pandemic, I am

temporarily residing at 9 Lipa Road, Philam Homes, Quezon City, Philippines;

4. I cannot go home to the province to secure the latest Barangay Certificate from Brgy.
Masaya, Bay, Laguna, Philippines;

5. Under oath, I declare that ______________________________________________, is

my permanent address. And I have been a permanent resident thereof since 2015 up to
present;

6. That this affidavit is being executed to attest to the truth of the foregoing, and for other
legal purposes this may serve.
.

IN WITNESS WHEREOF, I have hereunto set my hand this _______________________

at _______________.

Valid ID ___________

SUBSCRIBED AND SWORN TO before me this ___ in _______________, Philippines,

affiant exhibiting to me her competent evidence of identity by way of __________ issued at
__________ on ______________.

Doc. No. ________ NOTARY PUBLIC

Page No. ________
Book No. _______
Series of 2020