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Republic of the Philippines

City of Masbate

BEFORE ME, this _____________________ in the City of Masbate, personally appeared

Name Number Date & Place of Issue

Identification Card No.

known to me to be the same person who executed the foregoing instrument and she acknowledged to me that the
same is her free and voluntary act and deed.

IN WITNESS WHEREOF, I have hereunto set my hand this ______________ at Masbate City,

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2018.