REPUBLIC OF THE PHILIPPINES )

______ ) S.S

AFFIDAVIT OF RESIDENCY

I, ___________, of legal age, widowed, Filipino citizen and a bonafide resident of

____________________, Capiz, after having been duly sworn to in accordance with law, do
hereby depose ans state the following:

1. I am a currently residing at ________ shown in my Postal Identity Card, PRN

_______;

2. I am executing this Affidavit as a requirement for pensioners residing outside Japan

pursuant to “______”;

3. I am executing this Affidavit to attest to the truthfulness of the foregoing statement.

IN WITNESS WHEREOF, I hereunto affixed my signature this _______________, at

________, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this ________________ at______,

Philippines, affiant executing to me her valid proof of identity:

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2023.