REPUBLIC OF THE PHILIPPINES)

Province of ____________________) S.S.

City/Municipality of _____________)
x-----------------------x

TREASURER'S AFFIDAVIT

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

_____________, Philippines, after being sworn to in accordance with law, depose and state:

That I have been elected by the subscribers of __Name of Corporation__, INC. as

Treasurer thereof, to act as such until my successor has been duly elected and qualified in
accordance with the by-laws of the corporation, and that as such Treasurer, I hereby certify
under oath that at least twenty-five (25%) percent of the authorized capital stock has been
subscribed and at least twenty-five (25%) percent of the subscription has been paid and received
by me in cash for the benefit and credit of the corporation.

This is also to authorize the Securities and Exchange Commission (SEC) and Bangko
Sentral ng Pilipinas (BSP) to examine and verify the deposit in the __Name of Bank__
(_____________ Branch) in my name as Treasurer-in-Trust for __Name of Corporation__,
INC. in the amount of __________________________ (P_____________) representing the paid-
up capital of the said corporation which is in the process of incorporation. This authority is valid
and inspection of said deposit may be made even after the issuance of the Certificate of
Incorporation to the corporation. Should the deposit be transferred to another bank prior to or
after incorporation, this will also serve as authority to examine the pertinent books and records of
accounts of the corporation as well as supporting papers to determine the utilization and
disbursement of the said paid-up capital.

City of ______________, ___ ______, 2013.

Signature
________________________
(Treasurer’s Name)

SUSCRIBED AND SWORN to before me, Notary Public, for and in the City/Municipality of
____________, this ___ day of ___________, 20___ by ________________ with Driver’s
License number _____________, issued at _____________ on _____________, 20____.

Notary Public

Doc No.
Page No.
Book No.
Series of 20___.
REPUBLIC OF THE PHILIPPINES)
CITY/MUNICIPALITY OF ______) SS.
x------------------------------------x

ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in the (Province/City/Municipality) of

_____________, personally appeared _____________ with Community Tax Certificate No.
_____________ issued on _____________ at _____________, personally known to me (or
whom I have identified through competent evidence of identity) and who represented to me that
his/her signature on the foregoing instrument was voluntarily affixed by him/her for the purposes
stated in the instrument and who declared that he/she has executed the foregoing instrument as
his/her free and voluntary act and deed.

This Instrument consists of only ______ (____) page/s, including this page in which this
acknowledgment is written, duly signed by _____________ and his/her instrumental witnesses
on each and every page hereof.

WITNESS MY HAND AND SEAL this _____________ at _____________,

Philippines.

NOTARY PUBLIC

Doc. No. ______;

Page No. ______;
Book No.______;
Series of 20____.