REPUBLIC OF THE PHILIPPINES)

PROVINCE OF CAPIZ ) S.S.

MUNICIPALITY OF MAMBUSAO )
X---------------------X

AFFIDAVIT

I, JOVEY P. DALIVA, of legal age, Filipino, married, and a resident of Brgy.

Agambulong, Jamindan, Capiz, Philippines, after having been duly sworn to in
accordance with the law, hereby depose and state that:

1. I am the owner one (1) unit of chainsaw, with Serial Number 2021030007, which
I acquired on 03/09/2023;

2. I am currently applying/processing the permit/registration for my chainsaw with

the Department of Environment and Natural Resources (DENR), Community
Environment and Natural Resources Office (CENRO), at Poblacion Proper,
Mambusao, Capiz for the aforesaid chainsaw;

3. That the chainsaw is needed for my work/profession/business and will be used

for legal purposes only;

4. I am executing this Affidavit to attest to the truth of the foregoing facts and for
any legal purpose the same may serve best.

IN WITNESS WHEREOF, I have hereunto set my hand this

_______________________ at Mambusao, Capiz, Philippines.

JOVEY P. DALIVA
Affiant
Driver’s license No. F04-14-002995

SUBSCRIBED AND SWORN to before me this _____________________ in

Mambusao, Capiz, Philippines, by the affiant who exhibited to me his competent proof
of identity written below his name and signature.

Doc. No. ___;

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