Legal Forms – JOSEPH JOHN S.

RONQUILLO

1. Affidavit of Loss;

2. Affidavit of Support;

3. Acknowledgment of Paternity;

4. Affidavit of Cohabitation;

5. Affidavit of Free State/Singleness;

6. Affidavit of Late Registration of Marriage Contract;

7. Affidavit for Late Registration of Birth;

8. Pre-Nuptial Agreement ;

9. Affidavit of Guardianship;

10. Affidavit of Consent to Adoption by Parent;

11. Affidavit of Consent to Adoption by Minor;

12. Affidavit of Reconciliation of Birth Data;

13. Affidavit of Discrepancy (Spelling of Name/Surname);

14. Affidavit of Vehicular Accident;

15. Affidavit of Desistance;

16. Affidavit of Death Due to Vehicular Accident for Insurance Claim;

17. Affidavit of Publication;

18. Affidavit of Non-Operation;

19. Affidavit of Denial; and

20. Contract of Guard Services (Security Services).

 Jurat
 Acknowledgment
Republic of the Philippines)
San Mateo, Isabela) S.S.

AFFIDAVIT OF LOSS

KNOW ALL MEN BY THESE PRESENTS:

I, JOSEPH JOHN S. RONQUILLO, of legal age, Filipino, married, and a

resident of Barangay 04, San Mateo, Isabela, after having been sworn in
accordance with law, hereby deposes and states the following:

1. I am a former employee of Rural Bank of San Mateo (Isabela), Inc.;

2. I am formerly in-charged of the safekeeping of the stock certificates of the

stockholders of Rural Bank of San Mateo (Isabela), Inc.;

3. I have safe kept the Stock Certificate No. 462 owned by Ms. Anna Kovida;

4. Sometime in September 2016, I discovered that the Stock Certificate No.

462 was irretrievably lost and can no longer be found despite diligent efforts
to locate the same;

5. I execute this affidavit to attest to the truth of the foregoing.

Signed on the date and at the place indicated below.

JOSEPH JOHN S. RONQUILLO

Affiant

SUBSCRIBED and SWORN TO before me on the date and at the place indicated below.
The affiant exhibited to me his competent evidence of identity.

Signed this ____ day of April, 2022 at San Mateo, Isabela, Philippines.

WITNESS MY HAND AND SEAL.

Notary Public
Doc. No. _____
Page No._____
Book No. _____
Series of _____
 Republic of the Philippines)
San Mateo, Isabela) S.S.

AFFIDAVIT OF SUPPORT OF FACTS ALLEGED IN A

MOTION

I, JOSEPH JOHN S. RONQUILLO, of legal age, Filipino, married, and a resident of Barangay 04, San
Mateo, Isabela, after having been sworn in accordance with law, hereby deposes and states the
following:

That I, JOSEPH JOHN S. RONQUILLO, married and of legal age, currently working as a bank
employee of Rural Bank of San Mateo (Isabela), Inc.

That I personally know that the person named herein in the complaint and the person whom I
personally know are one and the same person.

That he is my officemate at Rural Bank of San Mateo (Isabela), Inc., and a friend of mine.

JOSEPH JOHN S. RONQUILLO

Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, A Notary public in and for the 3 rd district of Isabela
this 4th day of April 2022. Affiant personally came and appeared with Driver’s License ID No. B06-123456
issued by the Land Transportation Office and valid until June 1, 2022, at Cauayan City, bearing his
photograph and signature, known to me as the same person who personally signed the foregoing
instrument before me and avowed under penalty of law to the whole truth of the contents of said
instrument.

Notary Public

Doc. No. ______;

Page No. ______;

Book No. ______;

Series of 2022.
 AFFIDAVIT OF ACKNOWLEDGMENT OF PATERNITY

AND CONSENT TO USE THE SURNAME OF FATHER

I, __________________________________, _______________citizen of legal age, single/

married, and presently residing at ______________________________________________ after having
been duly sworn to in accordance with the law, do hereby depose and say:

That I am the biological father of the minor/ child ____________________________ who was
born on _____________________in ______________________________;

That at the time of the birth of said minor/ child, I was not legally married to his/ her biological
mother;

That I hereby acknowledge my paternity/ filiation of the minor/ child, ___________

___________________;

That I am giving my consent for the minor/ child to use my surname and that the same be
reflected in his/ her birth certificate;

That I am executing this affidavit to attest to the truth of the foregoing facts and for whatever
legal purpose it may serve.

IN WITNESS WHEREOF, I hereby affix my signature this _________________________________at the

____________________________.

________________________________________

Signature of Father over Printed Name

SUBSCRIBED AND SWORN to before me this ____ day of ______ 2022 in

_________, Philippines, affiant exhibiting to me his/her competent evidence of
identity by way of _______________ issued at ___________
on ________________.

Doc No. :  _____                                                             

Page No.: ______                                           
Book No.: ______                                              
Series of 2022                                                                Notary
REPUBLIC OF THE PHILIPINES
PROVINCE OF NORTHERN SAMAR
MUNICIPALITY OF SAN ROQUE

JOINT AFFIDAVIT OF COHABITATION

We, _______________________________ and ______________________________
both of legal ages, Filipinos, single and residents of Barangay_______________ San Roque,
Northern Samar, after being duly sworn to in accordance with law, depose and say:
1. That we have been living together as husband and wife without benefit of the lawful
marriage for more than five (5) years now;
2. That out of this union born two children.
_______________________ _______________________ _____________________
_______________________ _______________________ ______________________
3. That were not laboring under legal impediment to enter into a marriage, as we all
the qualifications and none of the disqualifications to contract marriage;

4. That we wish to validate and ratify our union into a lawful one in accordance with
the rites and performance, provisions of Article 34 of the Family code;

5. The we execute this affidavit to attest to the truth of all the foregoing statement for
the purpose as indicated above.

AFFIANTS FURTHER SAYETH NONE

_________________________________ _______________________________________

Affiant Affiant

CTC No. ____________________________________ CTC No. ____________________________

Issued at: ___________________________________ Issued at: ___________________________

Issued on: ___________________________________ Issued on: ___________________________

Signed in the presence of:

____________________________________ _____________________________________

Witness Witness

CTC No. ____________________________________ CTC No. ______________________________

Issued at: ___________________________________ Issued at: ____________________________

Issued on: ___________________________________ Issued on: ____________________________

SUBSCRIBED AND SWORN to before me this _______ day of _____________________, San
Roque, N. Samar
REPUBLIC OF THE PHILIPPINES)
CITY OF IMUS ) S.S.

AFFIDAVIT OF SINGLE STATUS

I, SASHA GREY, of legal age, Filipino, respectively, and presently residing at Blk 55, Lot
66, Ibarra Homes, Tulingan, Cavite, after having been duly sworn to in accordance with law,
depose and state:
1. THAT I have never contracted any marriage in the Philippines or elsewhere and I
remain SINGLE to this very day and hour;
2. THAT there is no legal impediment for me to contract marriage under the Philippine
Laws;
3. THAT I am executing this Affidavit for the purpose of complying with the
requirements relating to my forthcoming marriage to RON JEREMY in Caloocan City;
4. THAT I declare that the statements made in this affidavit are true and correct and I
am willing to bear all the legal responsibilities arising therefrom.
IN WITNESS WHEREOF, I have hereunto set my hand this 27th day of January 2022 in
Imus City, Cavite, Philippines.

SASHA GREY
Affiant
Voter's ID No. 5555

SUBCRIBED AND SWORN TO before me this 27th day of January 2022 in Imus City,
Cavite, Philippines, affiant exhibiting to me her valid proof of identification.
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2022.
 (Affidavit of Late Registration of Marriage Contract)

Republic of the Philippines)
Province of ________________)S.S.
City/Municipality of __________)

JOINT AFFIDAVIT

We, _________ and ___________, both Filipinos, of legal ages, and

residents of _____________, Philippines, having been duly sworn in
accordance with law, hereby depose and state:

That we know the person of _____________ as the same has been a close

acquaintance for a long period of time;

That we know for a fact that _____________ and _____________ were

lawfully joined together on _____________ in a marriage ceremony
solemnized by _____________;

That we are likewise aware that the date of marriage appearing

in the Certificate of Live Birth issued for their child, _____________, is
not the true and correct one as they have not yet taken each other as
husband and wife at the time of his birth;

That it was discovered but recently when _____________ requested for a

copy of their Marriage Contract from the Civil Registrar that the said
document has not yet been registered probably through oversight and
so the said Marriage Contract was only registered last _____________;

As such, we execute this Affidavit to certify or attest

to the truth of the foregoing facts and for whatever any and all legal
purposes that this Affidavit may serve.

IN WITNESS WHEREOF, we have set our hands this _____________, in

_____________, Philippines.

_________________________________ _______________________________________

Affiant Affiant

CTC No. ____________________________________ CTC No. ____________________________

Issued at: ___________________________________ Issued at: ___________________________

Issued on: ___________________________________ Issued on: ___________________________

SUBCRIBED AND SWORN TO before me this 27th day of January 2022 in Imus City,
Cavite, Philippines, affiant exhibiting to me her valid proof of identification.
Doc. No. _____;
Page No. _____;
 Book No. _____;
Series of 2022.

AFFIDAVIT FOR DELAYED REGISTRATION OF BIRTH

(Either the person himself if 18 years old or over, or father/mother/guardian may accomplish this affidavit)

I, ______________________________________________________ of legal age,

singles/married, and with residence and postal address at _____________________
_________________________________________________, after having been duly sworn to in
accordance with law, do hereby depose and say:

1. That I am the applicant for the delayed registration of my birth / or the birth of
_________________________________________________.

2. That I / he / she was born on ____________________________________ at

________________________________________________________;

3. That I / he / she is a citizen of _________________________________________;

4. That my / his / her parents are ________________________ and

_______________________
( ) married on _____________________ at ________________________

( ) not married but was acknowledged by my / his / her father whose name is
____________________________________________________;

5. That the reason for the delay in registering my / his / her birth was due to
___________________________________________________________________________
____________________________________________________;

6. That a copy of my / his / her birth certificate is needed for the purpose of
___________________________________________________________________________
____________________________________________________;

7. ( )(For the applicant only) That I am married to ________________________.

( ) (For the father/mother/guardian) That I/we am/are the _______________ of the said
person.

______________________

AFFIANT

SUBSCRIBED AND SWORN to before me this ____ day of ___________________, 20 ___ in the Philippine
Embassy, Abu Dhabi, UAE.

Service No. :
Doc. No. :

OR No. :

Fee Paid :

KNOW ALL MEN BY THESE PRESENTS:

This PRE-NUPTIAL AGREEMENT, entered into this _______ day of ___________________
20___ in __________, by and between JUAN DE LA CRUZ, and MARIA REYES, both of legal age,
and residing at
____________________________________________________________________.
WITNESSETH:
THAT the parties hereto are about to enter into a contract of marriage, tentatively
scheduled to take place sometime in _____month_______ 20___;
THAT they hereby mutually agree that all the property, real and personal, now owned by
the future wife, MARIA REYES, shall remain to be own exclusive and separate property, subject
to her disposition, administration, and enjoyment; while those of the future husband, JUAN DE
LA CRUZ shall likewise remain also to be his own exclusive and separate property, subject to
his absolute disposition and administration;
THAT all properties and earnings acquired after marriage by any party or jointly by both
parties shall constitute conjugal properties or funds which, among other common purposes,
shall defray or take care of family expenses, including the rearing and education of future
children that may be begotten or that may be adopted during the marriage;
THAT this agreement shall take effect upon the celebration of the marriage.
IN WITNESS WHEREOF, the parties hereto have signed their names unto this document
on the date and at the place first above written.
JUAN DE LA CRUZ MARIA REYES
Future Husband Future Wife
SIGNED IN THE PRESENCE OF:
_________________________ __________________________
ACKNOWLEDGMENT
Republic of the Philippines)
__________________________) SS.
BEFORE ME, a Notary Public in and for __________________, Philippines, this
____________________ personally appeared:
Name Res. Cert. No./ Date/Place
Passport No. Issued
JUAN DELA CRUZ ________________________
MARIA REYES ________________________
known to be the same persons who executed the foregoing instrument and they acknowledged
to me that the same is their free and voluntary act and deed.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my notarial seal on the date
and place first above written.
Doc. No. ______
Page No. ______
Book No. ______
Series of ______
 Republic of the Philippines )
City of ______               ) S.S.
x--------------------------x

AFFIDAVIT OF GUARDIANSHIP

            I, _________________, of legal age, single/married/widow,

Filipino citizen, and presently residing at _____________________, after
having been duly sworn to in accordance with law, do hereby depose and
say:

1.  That I am the ___(state relationship)__ and guardian of the following

minor/s who  has / have an interest in the _______________  of the
late _________________________ payable by ________________;

Full Name of Minor/s               Date of Birth                   Age

       _______________                 _________                   ______  
       _______________                 _________                   ______  
       _______________                 _________                   ______  

2.  That the above mentioned minor/s is/are under my care and custody; 

3. That I am competent to receive in behalf of the said minor/s any amount/s

due him/them; and 

4.  That I am not an imbecile, insane, a vagrant or a vicious person or

a habitual drunkard or a habitual criminal, and have not
abandoned, neglected or refused to support said minor/s or caused
him/them to commit offenses against the law. 

5.  That I am executing this affidavit to attest to the truth of all the foregoing
statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day

of _______ 2022 at ______________, Philippines.

                                                                                    _______________
_
                                                                                                Affiant
                                

            SUBSCRIBED AND SWORN to before me this ____ day of ______

2022 in _________, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of _______________ issued at ___________
on ________________.

Doc No. :  _____                                                             

Page No.: ______                                           
Book No.: ______                                              
Series of 2022                                                                Notary Public  

(Affidavit of Intent and Consent to Adoption of Child)

Republic of the Philippines)
Province of________________)S.S.
City/Municipality of ____________)
x-- - - - - - - - - - - - - - - - - - - x
JOINT AFFIDAVIT OF INTENT AND CONSENT
We,___________and__________,both Filipinos, of legal age, married
and presently residing at____________, Philippines, having been duly sworn
in accordance with law, hereby depose and state:
1.That we are the legitimate parents of ____________who was born
on____________in___________ Philippines.
2.That we have not, at any time abandoned said minor child. 
3.That we are unable to support said child and that believing that it
would be for (his/her)own interest and benefit, we, hereby signify our
written intent, freely and voluntarily to have our(son/daughter)
____________be adopted.
4.That we also signify our written consent, freely, willingly and
voluntarily to have our son/daughter)____________be legally adopted by
the spouses_________and___________of___________, Philippines in
accordance with law.
5.That we are ready and willing, freely and voluntarily to abdicate our
parental authority over said child in favor of the
spouses____________and_____________, who are ____and _____years of
age, respectively, and who are both possessed of the necessary civil and
legal rights as well as the financial capacity to raise, rear and support said
child, after the adoption proceeding had been instituted and an order of
adoption be issued.
6.That we execute this affidavit to declare our intention and
consent to the adoption of our (son/daughter)_________as well as to the
truth of the foregoing facts.
IN WITNESS WHEREOF, we have hereunto set our hands
this____________at"_____________, Philippines.
Affiant Affiant
            SUBSCRIBED AND SWORN to before me this ____ day of ______
2022 in _________, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of _______________ issued at ___________
on ________________.

Doc No. :  _____                                                             

Page No.: ______                                           
Book No.: ______                                              
Series of 2022                                                                Notary Public  

Republic of the Philippines )

Province of ________________ ) SS.
City/Municipality of _______ ) 
x- - - - - - - - - - - - - - - - - - - - - x

AFFIDAVIT OF RECONCILIATION OF BIRTH DATA

I, _______________________________, of legal age, single, Filipino citizen, and with

residence at ___________________________ after having been sworn in accordance with law,
do hereby depose and state that:

1. I was born to Spouses _______ and _________ of Calbayog City on May 10, 1976;

2. In the birth certificate which I obtained only recently, my family name is spelled
as "________________" instead of "_________________" to which I have I have been used to
as in my school records, SSS, BIR and other public documents. A copy of said birth certificate
which indicated my family name as "_______________" is hereto attached for reference;

3.   The names _________________ and ___________________ belong to one and the

same person, the undersigned herein;

4. That I am executing this affidavit in order to attest to the truth of foregoing circumstances
and for the purpose of setting the records straight and declaring that ____________________
and _________________________ refer to one and the same person.

IN WITNESS WHEREOF, I have hereunto affixed my signature on this _________ day

of ______________, 20 ______  in _______________________.

______________________
Affiant

SUBSCRIBED AND SWORN TO before me this _____ day of _________ at

________________ affiant exhibited to his/her competent evidence of identity by way of
_________________ issued on __________________ in _______________, Philippines.

Doc. No. _____

Page No. _____
Book No. _____
Series of _____.
 AFFIDAVIT OF DISCREPANCY IN NAME
I, _____________________, of legal age, married, and with address at
______________________________________________________, under oath,
state:
1. THAT my name is ____________________ as stated and registered in my
birth certificate issued by office of the Civil Registry of
______________________. A copy of my birth certificate is hereto attached as
ANNEX “A”;
2. THAT the name ___________________also appears in my passport which
was issued based on the data appearing in my birth certificate. A copy of the
page of my passport where my name and picture appears is hereto attached as
ANNEX “B”;
3. THAT since childhood, my friends and acquaintances call me ________and
thus since then I have been accustomed to using the
name ____________________in my personal records, transactions and
communications;
4. THAT the name ____________________ and _____________________ refer
to one and the same person, the herein Affiant;
5. THAT I am executing this Affidavit to attest to the truth of the foregoing facts
and to use the same for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I hereunto affix my signature this _________________

at Makati City.

________________________
Affiant

SUBSCRIBED AND SWORN to before me this _______________ at Makati City,

Affiant exhibiting to me his Passport bearing No.
______________________________ issued at ______________ on
_________________.

Doc No. ________;

Page No. _______ ;

Book No. _______;

Series of ________.

(Affidavit of Damage to Vehicle Hitting a Post while Backing)

Republic of the Philippines)
Province of_________________) S.S.
City/Municipality of___________)
x------------x

AFFIDAVIT
I,____________,Filipino, of legal age,(single / married / widow),and a
resident of__________, Philippines, after being sworn to in accordance with
law, depose and state:

1.That I am a duly licensed driver with Driver's License

No._____________covered by DLR No.___________, which is valid
until___________.

2. That on___________, at around_______, I was driving a motor vehicle

owned and registered in my name which is more particularly described as
follows:

Make____________ Motor No.:____________

Series:__________ Chassis No.:___________
Body Type:___________Plate No.:_____________
Year Model:___________MVRR No.:____________

3. That while I was slowly backing out of the driveway

along__________Street,____________,to park my car at the parking area
of___________, the aforementioned vehicle suddenly hit the post of the
building from where I was backing out and as a result the said vehicle
sustained damage at its __________;

4. That I am executing this Affidavit to attest to the truth of the forgoing and
in support of the claim against the insurer for the repair of the damage
caused to my vehicle

IN WITNESS WHEREOF,I have hereunto set my hand

this___________in___________, Philippines.

AFFIANT

            SUBSCRIBED AND SWORN to before me this ____ day of ______

2022 in _________, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of _______________ issued at ___________
on ________________.
Doc No. :  _____                                                             
Page No.: ______                                           
Book No.: ______                                              
Series of 2022                                                                Notary Public  

Republic of the Philippines)

Province of_________________) S.S.
City/Municipality of ____________)
x––––––––––––x

AFFIDAVIT OF DESISTANCE

I,__________, of legal ages, Filipino,(single / married / widow), and a resident of

____________, Philippines, after having been duly sworn in accordance with
law, hereby depose and say:

That I am the private complainant in the criminal case entitled “____________”;

for Theft docketed as____________before___________Trial Court, Branch
_____,__________City, Philippines;

That I found out that the said accused at the time of the incident was not in his
right mind and did not know that what he was doing was wrongful and criminal
considering that he was suffering from Schizophrenia, Paranoid Type in acute
exacerbation as certified to by Dr.____________of____________;

That the items taken by the accused, consisting

of____________and____________were immediately recovered from him and
their values had been voluntarily reimbursed by the relatives of the said Accused;

In view of the foregoing, I finally manifest that I now completely and absolutely
exonerate the accused__________from any liability in connection with the
above-mentioned criminal case and that I am no longer interested, and I hereby
desist, in prosecuting the said criminal case;

That I execute this Affidavit of Desistance so that the above-mentioned criminal

case be immediately dismissed and considered finally closed and the bond
posted by the herein accused be released to him;

As such, I am respectfully praying that the aforementioned case against the

Accused____________ be dismissed and finally closed.

IN WITNESS WHEREOF,I have hereunto set my hand

this____________at__________City, Philippines.

Affiant

            SUBSCRIBED AND SWORN to before me this ____ day of ______

2022 in _________, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of _______________ issued at ___________
on ________________.

Doc No. :  _____                                                             

Page No.: ______                                           
Book No.: ______                                              
Series of 2022                                                                Notary Public  
(Affidavit of Death Due to Vehicle Accident for Insurance Claim)

Republic of the Philippines)

Province of_________________) S.S.
City/Municipality of_____________)
x-------------x

AFFIDAVIT
I,____________,legal age, widow and a resident of____________, Philippines, after
having been duly sworn to in accordance with law, do hereby depose and state the following:
That I am the (widow/widower)of____________;
That my (husband/wife) died on_____________because of_____________injuries
sustained in a vehicular accident as per the results of the autopsy conducted by
Dr.____________;
That per investigation of the_____________Police Station, my (husband/wife) died as a
result of a vehicular accident at ____________ when while he was_____________, he was
bumped / hit by a truck coming from the opposite direction;
That my husband was a duly licensed driver at the time of the incident and was carrying
Driver's License No.____________and was riding on a_____________,_____________in color
and with Plate No._____________owned by _____________with Certificate of Registration
No._____________;
That I am executing this affidavit to attest to the truth of the foregoing and for whatever
legal purposes that this statement may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this_____________, in the City

of_____________, Philippines.

AFFIANT

            SUBSCRIBED AND SWORN to before me this ____ day of ______

2022 in _________, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of _______________ issued at ___________
on ________________.
 Doc No. :  _____                                                             
Page No.: ______                                           
Book No.: ______                                              
Series of 2022                                                                Notary Public  

REPUBLIC OF THE PHILIPPINES)
CITY OF MAKATI                      ) S.S.
x-------------------------------------x
  

AFFIDAVIT OF PUBLICATION

         I, JUAN B. DELA CRUZ, of legal age, Filipino, single and a resident of
1122 Washington Street, Pio del Pilar, Makati City, after having been duly
sworn to in accordance with law, depose and state:

1. That I am the Classified Ads Manager of the Daily News, Inc. a domestic
corporation duly organized and existing under and by virtue of Philippine
laws with office and business address at __________________________;

2. That the said corporation publishes THE DAILY NEWS, a newspaper of

general circulation published for the dissemination of local news and general
information with a bona fide list of subscribers published at regular weekly
intervals;

3. That an Alias Summons, Alias Process Server's Return, Order and Complaint
as per Civil Case No. 123456 entitled "ABCD vs. WXYZ", printed copies of
which are herewith attached, were published in the said newspaper on April
24, May 1 and 8, 2013.

         IN WITNESS WHEREOF, I have hereunto set my hand this 26th day
of September 2013 in Makati City, Metro Manila, Philippines.
          

JUAN B. DELA CRUZ

Affiant

    SUBCRIBED AND SWORN TO before me this 26th day of September

2013 in Makati City, Metro Manila, Philippines, affiant exhibiting to me his
Philippine Passport No. 123456 issued in Manila on January 12, 2012 and
valid until January 12, 2017.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2013. 
 Republic of the Philippines )
City of ______               ) S.S.
x--------------------------x

AFFIDAVIT OF NON-OPERATION

            I, _________________, of legal age, Filipino citizen, and

presently residing at _____________________, after having been duly
sworn to in accordance with law, do hereby depose and say:

1.  That I am the (state position in corporation) of (state name of corporation),

a corporation duly organization under the laws of the Philippines with
principal office at (state office address).

2.  That said corporation was incorporated on (state date of incorporation) with

SEC Registration Number (state SEC registration number).

3.  That to date, the corporation has not commenced operations due to (state
reason/s for non-operation).

4.  That  The stockholders and directors of the corporation intend to commence

operations in the future.

5.  That I am executing this affidavit in order to attest to the truth of the

foregoing and for the purpose of complying with the reportorial requirements
of the Securities and Exchange Commission.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day

of _______ 2022 at ______________, Philippines.

                                                                                    _______________
_
                                                                                                Affiant
                                                                                   

            SUBSCRIBED AND SWORN to before me this ____ day of ______

2022 in _________, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of _______________ issued at ___________
on ________________.

Doc No. :  _____                                                             

Page No.: ______                                           
Book No.: ______                                              
Series of 2022                                                                Notary Public  

REPUBLIC OF THE PHILIPPINES)
CITY OF MAKATI                       ) S.S.
x-------------------------------------x
  

AFFIDAVIT OF DENIAL

I, ___________________, of legal age, Filipino,

(single/married/widow) and a resident of
_______________________________, after having been duly sworn to in
accordance with law, depose and state:

1. That I was born on ________________ in

__________________________;

2. That I established my permanent residence in __________________,

Philippines;

3. That on ___________________, I applied for a Record Clearance from

the National Bureau of Investigation;

4. That I received an information from the National Bureau of Investigation

on ______________ that my namesake, a certain
_______________________, has a pending criminal case for Attempted
Homicide docketed as Criminal Case No. 1234 pending before Branch 67 of
the Metropolitan Trial Court of Quezon City;

5. That I hereby unequivocally deny involvement in the aforementioned

case;

6. That I also declare under oath that I am not in any way involved in any
case proceeding as either plaintiff/complainant or defendant/accused in the
Philippines and abroad, specifically with regard to the aforementioned case;

7. That I have been employed or residing in Hong Kong for ________ years
to this date;

8.That ___________________________________________________ (cite

other proof/s or reason/s to substantiate your claim that you are not
involved in the aforementioned case/s, if any); and

9. That I am executing this Affidavit to attest to the foregoing facts and to

deny absolutely and entirely any involvement in the case/s aforementioned
and for all legal intents and purposes.

IN WITNESS WHEREOF, I hereby affixed my signature

this ___________________ in Makati City, Metro Manila, Philippines.

____________________
Affiant

SUBCRIBED AND SWORN TO before me this _____________ in

______________, Philippines, affiant exhibiting to me his/her competent
evidence of identity by way of ______________ issued at _____________
on ______________.
   
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2013.
JURAT
 SUBSCRIBED and sworn to before me, in the city/municipality of __________________, this
___________ day of _________________, 20___________ by ___________________ with
Residence Certificate No. ________________ issued at ___________________ on
______________, 20_____.

                                                                                                      

                                                                            NOTARY PUBLIC
                                                                            My commission expires Dec. 31, 20__
                                                                            Not. Reg. No._____________________;
                                                                            Page No.________________________ ;
                                                                            Book ___________________________;
                                                                            Series of 20___________ 
REPUBLIC OF THE PHILIPPINES)
CITY/MUNICIPALITY OF ______) SS.

ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in the (Province/City/Municipality) of

_____________, personally appeared the following persons, with their respective
Community Tax Certificates as follows:

Name C.T.C. No. Date / Place Issued

1. ____________ _____________ _____________

2. _____________ _____________ _____________
3. _____________ _____________ _____________

all known to me and to me known to be the same persons who executed the
foregoing instrument which they acknowledged to me to be their free and
voluntary act and deed, consisting of only ______ (____) page/s, including this
page in which this Acknowledgement is written, duly signed by them and their
instrumental witnesses on each and every page hereof.

WITNESS MY HAND AND SEAL this _____________ at _____________,

Philippines.

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;

Book No. ______;

Series of ______;