REPUBLIC OF THE PHILIPPINES

(INFANTA, PANGASINAN )S.S.

AFFIDAVIT OF CONSENT

I, JOVIE DOCTOR MEDINA of legal age, Filipino Citizen and resident of Purok 5, Mangan-
Vaca, Subic, Zambales after being duly sworn depose and say that:

1. That I am legal owner of the Property located at Brgy Petal, Dasol, Pangasinan, I am
the lawful owner of the portion of the land under Tax Declaration of Real Property
No. 17-0013-02964.

2. That CRISTIAN GIL P. BOTARDO, is applying for an electric connection with PANELCO
I for his residential house.

3. That CRISTIAN GIL P. BOTARDO, had already constructed his house on a portion of
the said parcel of Land and he desires be connected with electricity.

4. That I hereby signify my written consent, freely, willingly and voluntarily to allow
CRISTIAN GIL P. BOTARDO, to install an Electric power on the said parcel of Land
aforementioned above.

5. That I am executing this affidavit to attest the truth of the foregoing as to

undertaking to give consent to CRISTIAN GIL P. BOTARDO and to support his
application for the installation of Electric Power and for whatever purpose it may
serve.

FURTHER AFFIANT SAYETH NOT.

JOVIE DOCTOR MEDINA

Affiant

SUBSCRIBE AND SWORN to before me this ____ day of ____________, 2024 at Infanta,
Pangasinan.

Doc No. ______

Page no. _____
Book No._____
Series of 2024.