Republic of the Philippines}

City of ______________ } s.s.

I, ________________, hereby acknowledge and certify that the Certification dated ____________,
issued by ____________________, is a true and faithful reproduction of the original, complete, and
that all statements and information provided therein are true and correct.

IN WITNESS WHEREOF, I hereby affix my signature this _____________ at ___________________.

_________________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, this __________________ at __________________, by

affiant _________________, who personally appeared and exhibited his ID bearing No. ______________,
valid until, as proof of identify.

WITNESS MY HAND AND SEAL.

Doc. No. ___; NOTARY PUBLIC

Page No. ___;
Book No. I ;
Series of 2019.