REPUBLIC OF THE PHILIPPINES

)S.S.

AFFIDAVIT OF AUTHENTICITY

The undersigned, _______________________, as the Chairman and the authorized

signatory of _________________Transport Service Cooperative, a cooperative registered
with the Cooperative Development Authority, with principal address at
____________________________________________________ with Telephone Nos.
__________________ after having been duly sworn to in accordance with law, hereby
depose, state and warrant that the following documents submitted to the Office of
Transportation Cooperatives (OTC) are authentic and the data/facts contained therin are true
and correct of my own personal knowledge, namely:

1. Letter of Intent:
2. Audited Financial Statement of the preceding year:
3. Duly Accomplished Annual Report;
4. Affidavit of Authenticity of Documents Submitted; and
5. Certificate of Compliance (COC) with CDA.

The undersigned further undertake to allow the Office Transportation Cooperatives,

or any of its authorized representative to verify any all documents which are necessary for the
issuance of our Certificate of Good Standing.

Finally, I hereby DECLARE and ASSUME full responsibility for any falsity or
misrepresentation of any material fact in the contents of the above-mentioned documents.

IN WITNESS WHEREOF, I hereby affix my signature this ___ day of ___________

2018 at ____________________.

_________________________
Chairman

SUBSCRIBED AND SWORN to before me this ____ day of ____________ 2018 at

__________________, with Community Tax Certificate No. _________________issued on
_________________ at ___________________.

Doc. No. _______

Page No._______
Book No._______
Series of 2018