REPUBLIC OF THE PHILIPPINES)

CITY OF ROXAS . . . . . . . . . . . . . ) S.S.

AFFIDAVIT
I, JUDITH R. DIVINO, of legal age, Filipino Citizen, married and a resident of Banica,
Roxas City, Capiz, subscribing under oath, depose and state:
1. That, I applied for Unified Multi-Purpose ID (UMID) Card;
2. That, allegedly, said UMID Identification Card was mailed to me at my residence;
3. That, up to this date however, I have not receive any UMID Identification Card;
4. That, I execute this affidavit to prove that I have not receive any UMID
Identification Card and do not posses the same and I hereby attest to the
truthfulness of the foregoing facts.;
IN WITNESS WHEREOF, I have hereunto affixed my signature this
_____________ at the City of Roxas, Capiz, Philippines.

JUDITH R. DIVINO
SUBSCRIBED AND SWORN TO before me, a Notary Public commissioned in
and for the City of Roxas, Province of Capiz, Philippines, this ___________________
by the affiant who is personally known to me and who has satisfactorily
proven to me her identity through her _____________________ ID with No.
__________________, bearing her photograph and signature, and that she is the same
person who appeared and signed the foregoing Affidavit in my presence within my
jurisdiction, and who avowed to the truth of its contents under the penalty of law.
Doc. No.: ______;
Page No.: ______;
Book No.: ______;
Series of 2016.