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I, Benjamin A. Santiaguel Jr., of legal age, Filipino, married and presently residing
at _______________________ after having been duly sworn to in accordance with law,
depose and state:
__________________
Affiant
Philippine Passport No. _____
Issued at: ________________
Issued on: ________________
____________________
Affiant
Philippine Passport No. _____
Issued at: ________________
Issued on: _______________