REPUBLIC OF THE PHILIPPINES)

Province of _________________________) S.S

City of _____________________________

JOINT AFFIDAVIT

We _____________________________________ and ___________________________

All of legal ages, both resident of_____________________________________________
_______________________ after having been duly sworn in accordance with law, hereby depose
and say:

1. That we are personally know ______________________________________________ a

Full _________ half _________ one fourth blooded _________member of the
Cultural communities belonging to the _____________________ tribe (s) was born
on _______________________ at ________________________________________

2. That his/her father ____________________________________________________ is a

Full _________________ half _____________ one forth __________ not a member
of the Cultural minorities belonging to the ___________________________________ tribe

3. That his/her Mother ___________________________________________________ is a

Full ________________Half ____________one forth ___________ not a Member
of the Cultural minorities belonging to the ____________________ tribe.

4. That we execute this affidavit to establish the fact that the above-named
Person is a bonafide member of the National Cultural Minorities

IN WITNESS WHEREOF, we hereunto affix our signature this__________ day of

_____________________ at ________________________________________

______________________________ ___________________________

Affiant Affiant

Res. Cert. No. ___________________ Res. Cert. No.________________

Date if issue ____________________ Date of issue ________________
Place of issue____________________ Place of issue ________________

SUBSCRIBED AND SWORN to before me this ______________ day of

______________________ at ___________________________ Affiants exhibited their
Res. Cert. No. As shown under their respective signatures.

_____________________________
Officer Administrative Oath