REPUBLIC OF THE PHILIPPINES )

_____________________________ ) S.S.

DECLARATION OF ACTUAL USE

(Within three (3) years from filing)

I, ___________________, of legal age, Filipino citizen with office address at

_____________________, hereby depose and state under oath that:

1. I am the authorized representative of ___________________________, the registrant

of the mark ________________.

2. The aforesaid mark ________ was accorded Registration No. _____________ on

__________ for Class _: ________________.

3. The mark _____________ is being used in the Philippines for ____________________.

4. As proof of actual use, attached are pictures of _______________ visibly showing the
mark ______________.

5. This affidavit is executed to attest to the truth of the foregoing and for the purpose of
complying with the requirements of R.A. 8293 and the Trademark Regulations, as
amended.

_____________________
Affiant

SUBSCRIBED AND SWORN to before me this ________________ at

______________________, Philippines, affiant having exhibited to me her
____________________ bearing her photograph as competent proof of her identity

Doc. No.____;
Page No.____;
Book No.____;
Series of 2023.