REPUBLIC OF THE PHILIPPINES)

CITY OF TALISAY )S.S.

AFFIDAVIT OF PAYMENT

I, ELBERTO A. MAGALLON, Filipino, of legal age, married, resident of Talisay

City, Cebu, Philippines, under oath, hereby depose and say:

1. That I am the proprietor and/or owner of blank office address located at blank.

2. That our said company has paid our employees wages, debts, and other
compensations due to them.
3. That we have paid all the material supplied and installed in this project including
taxes and other fees incurred due to the government relative in the prosecution of
the project.
4. That company obligated itself to indemnify and hold Persimmon Tower from and
against all claims that may arise.
5. That I have executed this affidavit for the purpose of securing payment for billing
in connection with interior painting on the 2nd and 3rd floors and for whatever
legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this date in the City of place.

ELBERTO F. MAGALLON
Affiant