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REPUBLIC OF THE PHILIPPINES } } S.S AFFIDAVIT I, _____________________________________ , of legal age, Filipino citizen with address At __________________________________________________after having been sworn in accordance with lieu, hereby dispose and say:

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REPUBLIC OF THE PHILIPPINES }

} S.S

AFFIDAVIT

I, _____________________________________ , of legal age, Filipino citizen with address

At __________________________________________________after having been sworn in accordance with lieu, hereby dispose and say: