REPUBLIC OF THE PHILIPPINES)

C I T Y O F M A K A T I ) S.S.

AFFIDAVIT OF ECONOMIC STATUS

That I, ARNULFO DASALLA PERALTA, of legal age, Filipino citizen, with

residence address at 8640 San Jose Street, Guadalupe Nuevo, Makati City,
Philippines, under oath, depose and say:

1. That I am applying for change of Green Card at the Makati Medical Center
(MMC) Health Service Program;

2. That I am not engaged to any business within or outside the Philippines;

further, I am not employed to any company;

3. That I am a senior citizen and have been separated since 2017, with no
communication with my 3 children since then;

4. That I hereby attest that under oath that I am receiving a pension from Social
Security System (SSS); whereas, the pension being received thereof is being
used to support for my financial needs;

5. That I am executing this affidavit to attest to the truth facts, in connection

with the Green Card application, and for whatever legal purpose it may serve.

AFFIANT FUTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereunto set my hand this 28 th day of January

2021, in the City of Makati, Philippines.

ARNULFO DASALLA PERALTA

Affiant

th
SUBSCRIBED AND SWORN to before me this 28 day of January 2021, in the
City of Makati, Philippines.

DOC. NO.
PAGE NO.
BOOK NO.
SERIES OF 2021