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Republic of the Philippines

Quezon City. Metro Manila

)
) S.S.
)

AFFIDAVIT
I
of
legal
age,_married/single/widow.
Filipino
with
permanent/postal
address
of
_________________________________________________________________________________after
having been duly sworn in accordance with law, do hereby depose and say:
That. I am a registered owner of firearms specified as follows:
Admin Control-No.
Kind
Make
Caliber
Serial No

:
:
:
:
:

That, I am a ______________________________________________,I and that due to the nature


of my work/job my life has been the subject of several threats, and
That, I am executing this affidavit to support my request for the approval of my PTCFOR.
That, to attest the truthfulness of the above statements, I hereto affixed my signature this
______day of_______________ , 2010, at Camp Crame, Quezon City.

________________________________
(Affiant)
SUBSCRIBED AND SWORN TO before me this _________day of __________ , 2010 at Camp
Crame, Quezon City. Affiant exhibited to me his Community Tax Certificate No. issued at ________ on
________ ,

Notary Public

Doc No. :
Book No
Page No.
Series of