REPUBLIC OF THE PHILIPPINES )

___________________________ ) S.S.

AFFIDAVIT OF NON-MEMBERSHIP
I, GILBERT DELACRUZ LAPUZ, of legal age, Filipino, with postal address at 1465 Uli Uli Street
San Miguel, Manila, having duly sworn in accordance with law, depose and state that:

1. I am an aspirant of the Manila Matikas Gideons Eagles Club, an association affiliated with The
Fraternal Order of Eagles—Philippine Eagles.

2. I do hereby certify that I have not applied for, nor have I ever been a member of, any other
organization affiliated with The Fraternal Order of Eagles—Philippine Eagles.

3. Should I find out later on that I have been enlisted as a member of any other Club affiliated with
The Fraternal Order of Eagles—Philippine Eagles, I shall, within five (5) days of knowledge
thereof, obtain a clearance from the other Club before I can pursue my application with Manila
Matikas Gideons Eagles Club.

4. I understand that if I am unable to secure a clearance with the earlier Club that I have purportedly
joined, I will stay with that Club until I am able to secure Clearance therefrom.

IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of __________________,
20__ at _________________

GILBERT D. LAPUZ
                 (Affiant)

 SUBSCRIBED AND SWORN TO before me this ____ day of _______________ at _______________,

Affiant exhibiting to me his/her competent proof of identity with his/her ________________ issued at
_____________________________ issued on __________________ valid until _______________.

NOTARY PUBLIC 
Doc. No. _____;
Page No. _____;
Book No. _____;
Series of 2022