AFFIDAVIT OF DESIGNATED REPRESENTATIVE OF

THE PROPONENT

I, Edwin S. Marasigan, hereby designate Rosalea D. Marasigan, as my official representative on

EDESSA Rice Mill with respect to the filing of Compliance Monitoring Report (CMR) in accordance with
Section 19 (a) of the Revised Procedural Manual for DENR Administrative Order No. 30, Series of 2003
and to confirm THAT:

1. All the information and commitments in this Compliance Monitoring Report (CMR) dated
___________________ for the _____(Name of Project)_____ with ECC Ref. No.
________________________________ are accurate and complete to the best of our
knowledge and documents available on file;

2. No DENR-EMB personnel was directly involved in the preparation of this Compliance

Monitoring Report (CMR); and

3. I hereby bind myself to answer any penalty that may be imposed arising from any
misrepresentation or failure to state material information in this CMR REPORT;

This designation will remain in effect until revoked by written notice.

IN WITNESS WHEREOF, I hereby set my hand this _____ day of ________________ at

_____________________________________.

_________________________
NAME OF PROPONENT HEAD
(Position)__________________
(Company Name)___________
(Valid ID No.)_______________

CONFORME:

_________________________
Name of Representative
(Valid ID No.)______________

SUBSCRIBED AND SWORN to before me this _____ day of _____________________, Affiant

exhibited to me his/her respective official identifying documents as stated above which are competent
evidence of identity.

Doc. No._______
Page No._______
Book No._______
Series of _______