REPUBLIC OF THE PHILIPPINES)

CITY OF
)

AFFIDAVIT OF OWNERSHIP
I, ( Name) of legal age, (citizenship) ____ of Tokmin Dick with residense address at _________ after
having been sworn to in accordance with law, do hereby depose and say:
1. That I am the sole owner of One (1) Pkg of Wine Refrigerator shipment..
2. That this shipment is covered by B/L No. PRM24059049 arrived at MICP-Manila North
Harbor arrived January 8, 2015 with Registry No. ADC0001-15.
3. That this shipment is not intended for sale but personal used only..
4. That I depose to this affidavit in good faith conscientiously believing its contents to be true
and correct and in accordance with the Oaths of Law.
IN WITNESS WHEREOF, I have hereunto set my hand this___ day of January 2015
_
Tokmin Dick
Affiant

SUBSCRIBED AND SWORN to before me this ________ day of 2015 in __________________.

Affiant exhibiting to me his Res. Certificate No. ________________ issued at __________________
on ________________2015.
Doc. No _______
Book No.______
Page No._______
Series of 2015