REPUBLIC OF THE PHILIPPINES . . . . . .

)
QEUZON CITY . . . . . . . . . . . . . . . . . . . ) s.s

AFFIDAVIT

I, _______________________________, of legal age, married, single, widow, and with

postal address at
_______________________________________________________________, after having
been duly sworn to in accordance with law do hereby depose and say;

That, __________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

That I attest that the foregoing statements and the submitted supporting documents are
true and correct to the best of my knowledge and belief and I commit myself to be liable for
perjury and/or dishonesty as a result of any fraud, false or misrepresentation in this affidavit.

IN TRUTH HEREOF, I hereunto affix my signature this ____ day of ___________

20___ at Quezon City.

___________________
( Affiant )

SUBSCRIBED AND SWORN to before me this ____ day of _______ 201__ at

______________________.

____________________
Administering Officer
REPUBLIC OF THE PHILIPPINES . . . . . . . . . )
QEUZON CITY . . . . . . . . . . . . . . . . . . . . . .) S.S

COMPLAINT AFFIDAVIT

I, _______________________________, of legal age, married, single, widow, and with

postal address at_____________________________________________, after having been
duly sworn to in accordance with law do hereby depose and say;

That, __________________________________________________________________,
presently assigned at ___________________________________________________________.

That, __________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________

That I attest that the foregoing statements and the submitted supporting documents are
true and correct to the best of my knowledge and belief and I commit myself to be liable for
perjury and/or dishonesty as a result of any fraud, false or misrepresentation in this affidavit.

IN TRUTH HEREOF, I hereunto affix my signature this ____ day of _______ 201__ at
Quezon City.

__________________
(Affiant)

SUBSCRIBED AND SWORN to before me this ____ day of _______ 201__ at

______________________.

____________________
Administering Officer