AFFIDAVIT

REPUBLIC OF THE PHILIPPINES )

CITY OF ____________________ ) S.S.

___________________, being first duly sworn, deposes and says:

That he is the Publisher/Editor of_____________________, a newspaper of general circulation

in________________, Philippines with business office at ________________________;
That the summons in the case of_____________________________, was published in said newspaper
for (state number of times) commencing ___________________ and ending _________________, a copy
of which publication is attached hereinbelow:

(Space for posting clipping)

That a copy of the above summons and order for publication had been deposited at the
___________________________ post-office, postage prepaid, directed to ________________ by registered
mail at ___________________________.

(Venue, Date)