AFFIDAVIT OF NO INCOME

Republic of the Philippines)

Province of ________________)
City/Municipality of _________)

I, _____________, of legal age, single/married, and with address at

________________________________, under oath, state that:

1. The last time I was gainfully employed was in year ____ until year _____as
________________ at ____________________.

2. I availed an early retirement on ___________.

3. In year ______-______, I have a source of income amounting to

_______________________Pesos only ( Php __________).

4. The said monthly income is from my__________________

5. From year _________ up to the present I have never engaged in any gainful
employment.

6. I am executing this AFFIDAVIT OF NO INCOME to attest to the truth of the

foregoing facts and to use the same for whatever legal purpose it may serve;

7. Affiant further sayeth naught.

IN WITNESS WHEREOF, I hereunto affix my signature this ________ day

of________ in the City/Municipality of _________, Province of __________, Philippines.

__________________________
Affiant – Declarant
TIN:______________________

SUBSCRIBED AND SWORN to before me, in ____________ personally appeared

this _________ at City/Municipality of _________.
NOTARY PUBLIC
Doc No:__________
Page No:_________
Book No:_________
Series of:_________