REPUBLIC OF THE PHILIPPINES )

Province of Leyte )
Municipality of Villaba ) S.S.
x--------------------------------------------x

AFFIDAVIT OF OWNERSHIP
I, GLICERIA G. TUNDAG, of legal age, Filipino, married, and a resident of Brgy.
Tabunok, Villaba, Leyte, Philippines, after having been duly sworn to in accordance with law,
hereby depose and state that:

1. I am the true and absolute owner and possessor of the following personal
properties, to wit:

ONE (1) TELEVISION SET ONE (1) KARAOKE

Brand– PHILIPS Brand– SHARP
Model –14GX351571R Model – HK-W
Serial No. – 545517453 Serial No. 60330574

ONE (1) REFRIGERATOR

Brand– SANYO
Serial No.: 55121248
Model No.- SR 507

2. The above-described personal properties are in my possession and are free of any
lien or encumbrance;

3. That I hereby warrant title and ownership over the above-mentioned personal
properties;

4. That I execute this Affidavit of Ownership to attest to the truth of the

aforementioned facts and in support of my renewal of my loan with Palompon
Community Multi-Purpose Cooperative Incorporated (PACCI) and for any other
legal purposes that this Affidavit could serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 21st day of March,
2019 at Villaba, Leyte, Philippines.

GLICERIA G. TUNDAG
Affiant

SUBSCRIBED AND SWORN to before me, this 21st day of March, 2019 at Villaba,
Leyte, by the Affiant who is personally known to me (or whom I have identified through competent
evidence of identity) and who exhibited her Voter’s ID No: 3751-0106A-L2852GGT20000 issued at
Villaba, Leyte.

NOTARY PUBLIC

Doc. No. ____;

Page No. ____;
Book No.XVI;
Series of 2019.