REPUBLIC OF THE PHILIPINES)

PROVINCE OF AGUSAN DEL SUR) S.S.

CITY OF ____________________)
X- - - - - - - - - - - - - - - - - - - - - - - - - X

AFFIDAVIT

I, ________________, of legal age, Filipino and a resident of

___________________________ ,Agusan del Sur, Philippines, after having
been duly sworn to oath in accordance with law, do hereby depose and say:

That I am the same person executing this affidavit;

That I am presently an applicant of the position of ______________ in

the Municipal Trial Court in Cities, ________________________;

That I have no incumbent relatives in the said office within the third civil
degree of consanguinity or affinity;

That I am executing this affidavit to establish the fact of the foregoing

statements

AFFIANT SAYETH NONE.

IN WITNESS WHEREOF, I have hereunto affix my signature this 27 th

day of August 2014 at _________________________, Philippines.

______________________
(Affiant)

Comm. Tax Cert. No.

Issued at:
Issued on:

SUBSCRIBED AND SWORN to before me this 27 th day of August 2014

at _______________________, Philippines.