Republic of the Philippines}

City of Baguio……………}

AFFIDAVIT

I, _____________________________, of legal age, Filipino citizen, a Civil Engineer,

and resident of ______________________________________________, Philippines, after
having been duly sworn to in accordance with law, do hereby depose and state that:

1. I am the supervisor/in-charge of civil/structural works of a particular project,

particularly: ___________title/name of project___________, situated at
_________________________________, Baguio City, and owned by
______________________________.

2. I attest to the fact that the said started/on-going/completed structure is in

accordance with the submitted structural plans, analysis, design,
specifications, National Building Code of the Philippines and the National
Structural Code of the Philippines;

3. I am executing this Affidavit to attest to the truthfulness of the foregoing and

for all legal intents and purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this, _______________, 2020,

at the City of Baguio, Philippines.

________________________________________
AFFIANT
PRC. No.__________ Validity:_________
PTR. No.__________ Date Issued:_________
Issued at ___________

SUBSCRIBED AND SWORN TO BEFORE ME this

_________________________________, at the City of Baguio, after Affiant had exhibited to
me his/her competent evidence of identity. I further CERTIFY that I have personally examined
the above-named Affiant and that I am fully convinced and satisfied that the foregoing
statements in this Affidavit were freely and voluntarily given, and fully understood by him.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2020.