REPUBLIC OF THE PHILIPPINES )

MUNICIPALITY OF CLAVER)
PROVINCE OF SURIGAO DEL NORTE) S.S.
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Sworn Declaration of Asset

I, RITO I. PLACENCIA, of legal age, Filipino with postal address at Brgy.
Hayanggabon, Claver, Surigao Del Norte after having been sworn in accordance with the
law hereby depose and state that:

1. I am the PROPRIETOR of POLARIS CONSTRUCTION AND GENERAL

SERVICES with principal address at Hayanggabon, Claver, Surigao del Norte;

2. That the following equipment and machineries are under the ownership of the
said company which are used in the daily operation of the business;

LIST OF ASSETS
POWER GENERATOR 1 DEUTZ-WEICHAI P 113,000
POWER GENERATOR 2 DEUTZ-WEICHAI P 113,000
POWER GENERATOR 3 NIPPON SHARYO, LTD P 1,080,000
POWER GENERATOR 4 DENYO P 650,000

3. The assets enumerated in the List of Assets provided above are the same as the
assets/inventories that were recently assessed and presently under the
possession of the company;

4. I am executing this undertaking to attest to the truth of the foregoing and for
whatever purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this

_____________________________ in Claver, Surigao Del Norte, Philippines.

RITO I. PLACENCIA
Affiant

SUBSCRIBED AND SWORN to before me this _____________________

in Claver, Surigao Del Norte, Philippines. The affiant personally appeared with his Id
bearing no. ___________________________ bearing her photograph and
signature, known to me as the same person who personally signed the foregoing
instrument an avowed under penalty of law to the whole truth of the contents of the said
document.

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