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REPUBLIC OF THE PHILIPPINES )

CITY OF MAKATI )S.S.

AFFIDAVIT OF ACQUISITION COST

I, EDILBERTO V. JAVIER, Filipino, married and with office address at Room


Unit 1215 Tower One & Exchange Plaza, Ayala Avenue, Makati City, under oath, do
hereby depose and state that:

1. I am the owner of a house and lot located at ________________, with a lot


area of _____ square meters sand covered by Transfer Certificate of Title No.
____, issued by the Registry of Deed of _____________, and Tax Declaration
Nos. _______ for the lot) and __________ (for the house) both issued by the
City Assessor’s office of ________ (the “Subject Property”);

2. I purchased the Subject Property in ____________ from _______________ at


a cost of ___________________, as documented by a Deed of Absolute
Sale, a copy of which is hereto attached as Annex “A” and made an integral
part of this Affidavit.

3. I am executing this affidavit to attest to the truth of the foregoing and in


connection with the transactions being processed by the Bureau of Internal
Revenue.

__th day of October 2002, City of Makati, Philippines.

EDILBERTO V. JAVIER
Affiant

SUBSCRIBED AND SWORN to before me this __th day of October 2002at the
City of Manila, affiant exhibiting to me his Community Tax Certificate No.
________issued on ________ at the City of _______.

Doc. No. : NOTARY PUBLIC


Page No.:
Book No.:
Series of 2002.

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