CITY OF MANILA
)
)s.s.
AF F I D AV I T
That I, __________________________, Filipino, married and with postal address c/o Jose
R. Reyes Memorial Medical Center, Manila after having been duly sworn to in accordance with
law, do hereby depose and say;
1.
2.
3.
4.
5.
6. That I am executing this affidavit to attest to the truth of the foregoing facts
and for the purpose of late registration.
IN WITNESS WHEREOF, I have hereunto affixed my signature this _____day of
_______, 2011 at the City of Manila, Philippines.
______________________________
Affiant
SUBSCRIBED AND SWORN to me this _____ day of _______ , 2011 affiant exhibited
to me his Residence Certificate No.21731967 issued at Mandaluyong City on January 17, 2011.
_______________________________
Chief Administrative Officer