REPUBLIC OF THE PHILIPPINES)

___________________________ ) S.S

AFFIDAVIT

We, (names of Homeowners Association [HOA] officers), all of legal age, Filipinos and
residents of (address), after having been duly sworn to in accordance with law, do hereby depose and say
that:

1. We are presently the New Set of Officers for 20__ to 20__ of (name of
HOA) registered at Social Housing Finance Corporation;

2. We certify that Mr./Ms. (name of member-beneficiary [MB]) of Block

___ Lot ___ is a delinquent member of said association since (date when the MB
defaulted in payment) and were reminded to comply/update all his/her arrearages,
sending demand letters in his/her postal address but failed to comply until the Board of
Directors decided to terminate his/her Lease Purchase Agreement (LPA). Attached
herewith are the demand letters sent to Mr./Ms. (name of MB);

3. We are executing this affidavit to attest to the truth of the facts

aforementioned; and

4. Further, we are executing this affidavit in compliance with SHFC

Corporate Circular No. 16-046, Series of 2016 regarding the Amendments to the
Guidelines on Substitution of MBs.

            IN WITNESS WHEREOF, WE have hereunto set our hands this ___ day of ________ 20____ at
____________.

______________________________ _____________________________
Affiant                                          Affiant
ID No.                            ____                 ID No.                           ____
Issued on                                                      Issued on                             
Issued at                                                        Issued at                               

______________________________
Affiant
ID No.                            ____
Issued on ________________
Issued at _________________

            SUBSCRIBED AND SWORN to before me this ___ day of ____________ 20___ at
____________ by affiants, who have satisfactorily proven to me their identity through their identifying
documents written below their name and signature, that they are the same persons who personally signed
before me the foregoing Joint Affidavit of Three Disinterested Persons and acknowledged that they
executed the same.
                                                                                  
Doc. No. ___;                                                                          
Page No. ___;                                                             
Book No. ___;                                                             
Series of 20__.