REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA )

AFFIDAVIT OF RECONNECTION

That I, JOSE MARTIN ROY MONIDO, of legal age, Filipino citizen, a resident of
9697 Diamond St., Umali Subd., Los Baños, Laguna, after having been duly sworn according to
law depose and say:

1. That my grandfather, Eduardo V. Roy, a concessionaire of the LARC Servicing

Arcadio and Magdalena Apartment, 9697 Diamond St., Umali Subd., Los Baños,
Laguna with Account No. 192-12-116 F;

2. Accordingly, in my capacity as representative of my grandfather, I am requesting

the LARC concerned to reconnect the said account;

3. That I am executing this affidavit to attest to the facts stated herein relative to my
request to the LARC to reconnect water service of the said account subject to
foregoing rules and regulations

IN WITNESS WHEREOF, I affixed my signature this 8 th day of February 2022 at

Manila, Philippines.

JOSE MARTIN ROY MONIDO

Affiant
Driver’s License No.: D12-16-002311

SUBSCRIBED AND SWORN to before me on the date and place stated above.

Doc. No. ____;

Page No. ____;
Book No. ____;
Series of 2022.