REPUBLIC OF THE PHILIPPINES)

PROVINCE OF SURIGAO DEL SUR) s.s.

CITY OF TANDAG)

AFFIDAVIT
(TIN CARD)

I, FLORENCE BIOL y TECSON, Filipino, 31 years old, single, and a resident of

San Agustin Sur, Tandag City, Surigao del Sur, Philippines, after having been duly
sworn to in accordance with law, depose and state:

1. That I am the same person registered under Taxpayer Identification No.

301-620-596 before the Bureau of Internal Revenue, Biñan, Laguna;

2. That as such, I was supposed to be issued by said Office with a TIN Card,
unfortunately, the same was not claim by me while I was still in Biñan, Laguna, hoping
that the same can be claim here in BIR-Tandag City;

3. That it was until then that I realize the same it is not allowed by their
Office;

4. That I am executing this Affidavit to attest to the veracity of the foregoing

and to support my application for the issuance of a TIN Card from the Bureau of
Internal Revenue-Tandag City and not to defraud anybody.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 28 th day of

May, 2013 at Tandag City, Surigao del Sur, Philippines.

FLORENCE T. BIOL
AFFIANT

SUBSCRIBED AND SWORN TO before me this 28TH day of May, 2013 at

Tandag City, Surigao del Sur, Philippines. The identity of the affiant is established by
her SSS Identification Card with No. 33-8606005-9.