REPUBLIC OF THE PHILIPPINES )

Municipality of Bangued ) S.S

Province of Abra )

BEFORE ME, this ________________, personally appeared, _________________________, known to

me and to me known to be the same person, who executed the foregoing instrument and acknowledgment to
me that the same is here free act and voluntary deed.

WITNESS MY HAND AND SEAL at the date and place first above written.

Doc. No. ________

Page. No._______
Book No.________
Series of 20______