Republic of the Philippines)

Done in the City of Baguio) S.S.

AFFIDAVIT OF NO INCOME

I, CORAZON A. VILLANUEVA, legal age, married, Filipino citizen, with

residence and postal address at #20 Cresencia Village, Baguio City, Philippines
after having been duly sworn to in accordance with law hereby depose and
state that:

1. I am CANCER PATIENT applying for MEDICAL ASSISTANCE for my

CHEMO THERAPY;

2. I am not employed to any government entity nor self-employed, hence,

have no regular income;

3. I am executing this Affidavit to attest to the veracity and truthfulness

of my foregoing statement and to support my application for Medical
assistance and for all legal intents and purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 9 th day of

February, 2018 at Baguio City, Philippines.

CORAZON A. VILLANUEVA
AFFIANT
OSCA ID No.: 28265
Date of Issue: 07-29-15

SUBSCRIBED AND SWORN to before me this 9th day of February, 2018

at Baguio City. Affiant personally appeared before me and to be the same
person who executed this instrument freely and willingly.

MODESTO T. ANDONG
Notary Public
Commission No. 39-NC-18-R/Until: December 31, 2019
PTR No. 3397734/12-13-2017/Baguio City
IBP No. 1083758/12-13-2017/Baguio-Benguet Chapter
Roll No. 31289/5-15-81/Manila
Doc. No. 258; MCLE COMPLIANCE No. VI-0000192/June 14, 2016
Page No. 53; BIR TIN No. 121-017-652
Book No. XXVIII; No. 19, 2nd Floor Old Market Bldg.,
Series of 2018. Magsaysay Ave., Baguio City, Philippines