VERIFICATION

REPUBLIC OF THE PHILIPPINES)

Province of ____________________) S.S.
City/Municipality of _____________)
x-----------------------x

I, _____________, of legal age, Filipino, (single / married / widow), and a resident of

_____________, Philippines, after being sworn in accordance with law, hereby depose and say:

1. That I am the __position__ of __corporation__, the (Plaintiff / Complainant /

Petitioner) in the above-entitled case;

2. That in my capacity as such __position__, I have caused the preparation of the above
(Complaint / Petition) and I have read the same and knows the contents thereof; That
the allegations contained therein are true and correct of my own personal knowledge
and the authentic records at hand.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at

_____________, Philippines.

AFFIANT

SUBSCRIBED AND SWORN to before me, this _____________, by _____________

who exhibited to me (his/her) Community Tax Certificate No. _____________ issued at
_____________, Philippines on _____________.

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______;