REPUBLIC OF THE PHILIPPINES)

PROVINCE OF AKLAN )S.S.

MUNICIPALITY OF MALAY )
x-------------------------x

AFFIDAVIT

I, __________________, of legal age, Filipino, and a resident of 7stones Boracay,

Bolabog Beach, Balabag, Boracay Island, Malay, Aklan, 5608, after having been duly sworn
to in accordance with law, do hereby depose and say:

1. That I know XXX of legal age, Filipino citizen, and currently residing at Valladolid,
Loboc, Bohol;

2. That _____________________ Contract Account No. 000050019488 as well as

_________________________. (AKELCO) Account No. 2020027181 are both
registered under the name of XXX;

3. That XXX is no longer residing at _____________________________ and has

migrated to Valladolid, Loboc, Bohol;

4. That JOAN is no longer a concessionaire/customer of _____________________

and ____________________ and is no longer using the above stated account
numbers;

5. That the witness YYY, of legal age, Filipino and likewise a resident of
_______________________, used to be neighbors with XXX;

6. That I am executing this affidavit to attest to the truth of the foregoing facts for all
legal intents and purposes;

IN TESTIMONY WHEREOF, I have hereunto set my hand this 30th day of

July, 2019 at _________________.

______________________________
Affiant

Signed in the presence of: YYY

SUBSCRIBED AND SWORN TO BEFORE ME, 30th day of July, 2019 at

Malay, Aklan personally came and appeared _______________________ with Passport
P1238508A issued by the DFA April 2017 and in the company of one Mr YYY who has
affirmed on oath the identity of the said Miss __________________ and who is personally
known to the undersigned Notary Public, not interested as a party to the foregoing
instrument, and who acknowledged before me that the instrument is his free and voluntary
act and deed.
Doc. No._________;
Page No._________;
Book No._________;
Series of 2019.