Republic of the Philippines

City of Iloilo
)
X------------------------------X

AFFIDAVIT
I, ____________________, of legal age, single, Filipino and a resident of
Jalandoni Estate, Lapuz, Iloilo City after having been duly sworn to in
accordance with law hereby depose and say:
That I am applying for _____________;
That said school is requesting for a COPY of our electric bill;
That I cannot provide said copy of electric bill since we are only
connecting from the house of ______________, and that we do not have an
electric connection;
That I am executing this Affidavit in order to attest to the truth of the
foregoing facts for whatever legal purpose this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this 17 th day of
May 2016 at Iloilo City, Philippines.

_______________
Affiant
SUBSCRIBED AND SWORN to before me this 17 th day of May 2016,
at Iloilo City, Philippines. Affiant exhibited to me her ________ with no.
___________ as proof of Identity.
WITNESS MY HAND AND NOTARIAL SEAL.
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2016.