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REPUBLIC OF THE PHILIPPINES)

___________________) S.S.

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AFFIDAVIT OF DECLARATION OF OWNERSHIP

I__________________, of legal age, F l ! "o, # "gle, $a"age% of R&' "(o"#Co%!o%a o", af e% *a+ "g 'ee" &l # o%" o " a//o% a"/e * la , e!o#ea" # a e0

1. T*a #a ____________________ # *e o "e% of /e% a " !a%/el of la" , 2o%e!a% /&la%l e#/% 'e a# follo #0

3Te/*" /al De#/% ! o" of P%o!e% )

4. T*a *e #a afo%e2e" o"e T%a"#fe% Ce% 5/a e of T le o+e% #a !%o!e%"/l& e# a" /o" a "# all *e !e%2a"e" 2!%o+e2e" # a" '& l "g# lo/a e

a" # &a e *e%eo".6

7. T*a I exe/& e * # A8 a+ o a e# a" e/la%e *e %& * of *e fo%ego "gfa/ # a" fo% *a e+e% legal !&%!o#e# *a * # A8 a+ 2a #e%+e.

IN WITNESS WHEREOF, I *a+e *e%e&" o #e 2 *a" * # ____ a of ________________ " _______________, Neg%o# I#la" , P* l !! "e#.

_________________

A8a"

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SUBCRIBED AND SWORN TO 'efo%e 2e * # ____ a of ___________ 49__ " _______ C :$&" / !al ___________, P* l !! "e#, a8a" ex* ' "g o 2e * # _________________________ ##&e " ____________________a" +al &" l ______________.

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