COMMONLY USED FORMS

REPUBLIC OF THE PHILIPPINES)

CITY OF MANILA ) S.S.

AFFIDAVIT OF LOSS

I, _______________________, of legal age, single and residing at

____________ after having been duly sworn to according to law hereby depose
and state:
1. That I am the owner of a Nokia cellphone model 6150 with unit number
0917-5555555 under account number 222222;
2. That on the 30th of October, 2002 with a number of books and packages I
was carrying while getting out my car, my said cellphone must have slipped
from my pocket because after I reached my office, I hurriedly tried to get my
said cellphone from my pocket but I was a little bit shocked as it was not
there anymore;
3. That after diligent search inside my car and the stairs and elevator used
going up my office, my said cellphone was nowhere to be found anymore;
4. That I am executing this affidavit in order to attest to the truth of the
foregoing circumstances and for the purpose of reporting the loss to the
Globe business center.

IN WITNESS WHEREOF, I have hereunto set my hand this ___day of

____________, _______ at _____________.

_______________________
Signature of Affiant

SUBSCRIBED AND SWORN to before me, this ____________, by

____________ who exhibited to me (his/her) Community Tax Certificate No.
__________ issued at ___________________, Philippines on _____________.

NOTARY PUBLIC
Doc No. ____
Page No. ____
Book No. ___
Series of ____
 REPUBLIC OF THE PHILIPPINES)
CITY OF MANILA ) S.S.

AFFIDAVIT OF SUPPORT

We, spouses _____________ and _______________, both of legal age,

Filipino citizens and residing at _____________, after having been duly sworn
to according to law, hereby depose and state:
1. That we are the legitimate parents of ______________ who is ___ years old;
2. That our above-named son is scheduled to leave for the United States on
__________ for about a month vacation with our sister and his aunt who
resides at #6 Eagle Rock Blvd., Los Angeles, California;
3. That since our said son is travelling alone and is still a minor, we hereby
give our consent freely and voluntarily for him to travel to the United States
on said date.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of
___________, at ____________.

____________________ ____________________
Father’s Signature Mother’s Signature

SUBSCRIBED AND SWORN to before me, this ____________, by

________ who exhibited to me (his/her) Community Tax Certificate No. ________
issued at ___________________, Philippines on _____________.

NOTARY PUBLIC
Doc No. ______
Page No. ______
Book No. _____
Series of ______
REPUBLIC OF THE PHILIPPINES)
CITY OF MANILA ) S.S.

AFFIDAVIT OF VEHICULAR ACCIDENT

I, ___________________, of legal age, married and with residence address at

_____________ after having been duly sworn to according to law, hereby depose and
state:
1. That I am the registered owner of a motor vehicle which is specifically described
as follows:
TOYOTA COROLLA XL 4-DOOR SEDAN
MODEL:
MOTOR NO.:
CHASSIS NO.:
COLOR:
PLATE NO.:
2. That said motor vehicle figured in an accident on October ____, at about _____
A.M./P.M. while I was driving it along Stella Maris St. and I was trying to turn
left at the corner of Dr. Sixto Antonio Avenue in Pasig City, an Isuzu Elf with
Plate No. __________________ driven by certain ________ tried to overtake me
in the inner portion of that corner thus grazing and scraping the left hand fender
liner, left hand side view mirror, dents in the front and rear doors on the left hand
side which thus sustained considerable damage to my said vehicle.
3. As we are both in a hurry and I was still in my bedroom shorts as I was just about
to bring my daughter to school, we did not bother anymore to summon a
policeman to record the accident;
4. That I am executing this affidavit in order to attest to the truth of the foregoing the
circumstances and for the purpose of reporting the matter to my insurance office
for insurance claims.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day

of_____________, 20___ at the City of Makati.

_____________________
Signature of Affiant

SUBSCRIBED AND SWORN to before me, this ____________, by ________

who exhibited to me (his/her) Community Tax Certificate No. ________ issued at
___________________, Philippines on _____________.

NOTARY PUBLIC
Doc No. ______
Page No. ______
Book No. _____
Series of ______
REPUBLIC OF THE PHILIPPINES)
CITY OF MANILA ) S.S.

AFFIDAVIT OF DESISTANCE

I, ______________________, of legal age, single and residing at _____ after

having been duly sworn to according to law hereby depose and state:
1. That I am the complainant in the criminal case filed against _____________,
which is recorded as Case No. __________ before Prosecuting Fiscal
__________ of the municipality of ____________ for grave threats;
2. That after nulling over the mulling over the incident for some time and
thinking that it was just a case of misunderstanding between me and my
neighbor, I have decided to withdraw mu accusations against
________________;
3. That I have executed this affidavit in order to attest to the truth of the
foregoing circumstances and that my desistance to pursue said case is of my
own free will and volition and that there was no coercion or consideration
that took place for me to make such decision.
IN WITNESS WHEREOF, I have hereunto set my hand this ____________
day of ________, 20____ at __________________.

______________________
Signature of Affiant

SUBSCRIBED AND SWORN to before me, this ____________, by

________ who exhibited to me (his/her) Community Tax Certificate No. ________
issued at ___________________, Philippines on _____________.

NOTARY PUBLIC
Doc No. ______
Page No. ______
Book No. _____
Series of ______
REPUBLIC OF THE PHILIPPINES)
City/Municipality of ____________) S.S.

AFFIDAVIT OF PUBLICATION

I, _____________________, of legal age, Filipino, married and resident

of_______________, after having been duly sworn to according to law, hereby
depose and state:

1. That I am the Classified Ads Manager of the __________________,

publisher of the Phil. Star which is being published daily in English, of
general circulation with editorial and business address at ______________;
2. That at the order of _____________, Extrajudicial Settlement of Estate of
the late ___________ dated __________ was published in this newspaper in
its issues of ________________.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of

_________, 20___ at __________________.

______________________
Signature of Affiant

SUBSCRIBED AND SWORN to before me, this ____________, by

________ who exhibited to me (his/her) Community Tax Certificate No. ________
issued at ___________________, Philippines on _____________.

NOTARY PUBLIC
Doc No. ______
Page No. ______
Book No. _____
Series of ______
REPUBLIC OF THE PHILIPPINES)
City/Municipality of ___________) S.S.

AFFIDAVIT OF NON-OPERATION

1. That I am the President of _________________, a corporation duly

organized and existing under the laws of the Philippines with principal office
at ________________;
2. That said corporation was incorporated in February 21, 1968 and acquired
with the purchase of its corporate property in the above address sometime in
March, 1986 but has not yet commenced its operation in view of the slump
in the real estate industry in the country;
3. That the stockholders and directors of the corporation are contemplating on
reviving its operation in the near future when the opportune time comes;
4. That this affidavit is being executed in order to attest to the truth of the
foregoing circumstances and for the purpose of complying with the
reportorial requirements of the Securities and Exchange Commission.

IN WITNESS WHEREOF, I have affixed my signature on this _________

day of _______, 20___ at _________________.

___________________
Signature of Affiant

SUBSCRIBED AND SWORN to before me, this ____________, by

________ who exhibited to me (his/her) Community Tax Certificate No. ________
issued at ___________________, Philippines on _____________.

NOTARY PUBLIC
Doc No. ______
Page No. ______
Book No. _____
Series of ______
REPUBLIC OF THE PHILIPPINES)
City/Municipality of ____________) S.S.

AFFIDAVIT OF DENIAL

1. That I am the President of __________________ Corporation and in my

capacity as such I enter into numerous transactions which sometimes would
require background investigation by entities I deal with;
2. That due to the fact that the name PEDRO CRUZ seems to be very common,
I was told that there have been several namesakes with criminal or
derogatory records found in the NBI records, a copy of which is hereto
attached for reference;
3. That I would like to categorically state herein that I have no pending
criminal or civil cases filed against me by any person or entity and that cases
dug up in NBI records are merely namesakes and none of them are actually
mine;
4. That further, I wish to refute herein that I am the person with pending court
cases as my middle name is “Arespacochaga” and I am married to “Julia
Roberts-Cruz” and have been a resident of the above address for more than
30 years now and have neven been a resident of any of the addresses
mentioned in the attached NBI records;
5. That I am executing this affidavit in order to attest to the veracity of the
foregoing circumstances and for the purpose of denying herein that I am the
same person referred to in the said list of Pedro Cruzes.

IN WITNESS WHEREOF, I have hereunto set my hand this _______ day of

___________, 20___ at ___________________.

________________
Signature of Affiant

SUBSCRIBED AND SWORN to before me, this ____________, by

________ who exhibited to me (his/her) Community Tax Certificate No. ________
issued at ___________________, Philippines on _____________.

NOTARY PUBLIC
Doc No. ______
Page No. ______
Book No. _____
Series of ______
REPUBLIC OF THE PHILIPPINES)
City/Municipality of ____________) S.S.

AFFIDAVIT OF FREE STATE

1. That I am the sister of _____________________ who was born on

_______________, in ________________;
2. That I used to stay with my parents and my above named sister until I got
married on ________________ when I transferred to the above address;
3. That as _____________’s sister, I certainly know her to be single and that
she has never been married before either civilly or in a religious ceremony;
4. That I am executing this affidavit in order to attest to the veracity of the
above circumstances and for the purpose of compliance with the
requirements of the Church of ____________ in Hongkong for said sister’s
impending marriage in said church on ___________ to Mr. _________, also
a resident and citizen of the Philippines.

IN WITNESS WHEREOF, I have hereunto set my hand on this

____________ day of ____________, 20___ at ____________.

____________________
Signature of Affiant

SUBSCRIBED AND SWORN to before me, this ____________, by

________ who exhibited to me (his/her) Community Tax Certificate No. ________
issued at ___________________, Philippines on _____________.

NOTARY PUBLIC
Doc No. ______
Page No. ______
Book No. _____
Series of ______
REPUBLIC OF THE PHILIPPINES)
City/Municipality of____________) S.S.

AFFIDAVIT OF RECONCILIATION
OF BIRTH DATA

I, (ANA RECAFRANCA), of legal age, single and with residence address at

________________, after being duly sworn to according to law, hereby depose and
state:
1. That I am the daughter of the couple _______________ and
________________ of Calbayog City and I was born on May 9, 1966;
2. That in the birth certificate which I obtained only recently, my family name
is spelled as “Recafranca” instead of “Ricafranca” to which I have been used
to as in my school records, SSS, BIR and other public documents;
3. That a copy of said birth certificate which indicated my family name as
“Recafranca” is hereto attached for reference;
4. That the names Ana Recafranca and Ana Ricafranca belong to one and the
same person, the undersigned herein;
5. That I am executing this affidavit in order to attest to the truth of foregoing
circumstances and for the purpose of setting the records straight and
declaring that Ana Recafranca and Ana Ricafranca refer to one and the same
person.

IN WITNESS WHEREOF, I have hereunto set my hand this _________ day

of _____________, at ________________.

____________________
Signature of Affiant

SUBSCRIBED AND SWORN to before me, this ____________, by

________ who exhibited to me (his/her) Community Tax Certificate No. ________
issued at ___________________, Philippines on _____________.

NOTARY PUBLIC
Doc No. ______
Page No. ______
Book No. _____
Series of ______
REPUBLIC OF THE PHILIPPINES)
Province of ___________________) S.S.
City/Municipality of ____________)

AFFIDAVIT OF DISCREPANCY

I, JOSE DELA FUENTE, of legal age, married, Filipino and a resident of

_______________, Philippines having been duly sworn in accordance with law,
hereby depose and state:
1. That on _______________, I was issued a Philippine Passport with passport
number ______________ in which my true surname DELA FUENTE was
stated;
2. That before the expiration of the aforementioned passport on _________, I
had applied with Philippine Embassy in ___________ for the issuance of a
new passport and on _____________, I was issued a new Philippine
passport with passport no. _________________;
3. However, in the said new passport my surname had been erroneously
misspelled as DELA FUENTES;
4. That I execute this Affidavit of Discrepancy to attest to the truth of the
foregoing circumstances and to explain the discrepancy in my Philippine
Passport with regard to my surname.

IN WITNESS WHEREOF, I have hereunto set my hand this

______________, at ___________________, Philippines.

___________________
AFFIANT

SUBSCRIBED AND SWORN to before me, this ____________, by

________ who exhibited to me (his/her) Community Tax Certificate No. ________
issued at ___________________, Philippines on _____________.

NOTARY PUBLIC
Doc No. ______
Page No. ______
Book No. _____
Series of ______
REPUBLIC OF THE PHILIPPINES)
Province of ___________________) S.S.
City/Municipality of ____________)

QUITCLAIM

KNOW ALL MEN BY THESE PRESENTS:

I, __________________, of legal age, single/married, and residing at

_________________, after having been duly sworn to according to law, hereby depose
and state:

1. That I am an employee of __________________ having connected therewith as

__________, since _______________;
2. That I have a letter of resignation with the company effective _____________;
3. That I hereby relieve and discharge said (name of company) and its officers from
any and all claims by way of unpaid wages, separation pay, overtime pay, 13 th
month pay or otherwise as may be due me or incident to my employment with said
company;
4. That I hereby state further that I have no claim, right or action of whatsoever
nature, whether past, present or contingent, against said company and its officers;
5. That the contents of this document, although prepared in English, was interpreted
and explained to me in Pilipino by the undersigned Personnel Officer and the same
is therefore understood by me;
6. That I am executing this instrument freely and voluntarily without any moral or
physical threat, coercion or promise of reward in any form.

IN WITNESS WHEREOF, I hereby affixed my signature this ______ day of

____________ at __________________.

___________________
Signature of Employee

SIGNED IN THE PRESENCE OF: Signature (Personnel Officer)

_____________________
Signature (Union Officer)

REPUBLIC OF THE PHILIPPINES)

City/Municipality of ____________) S.S.

ACKNOWLEDGMENT

BEFORE ME, a Notary Public for and in the (Province/City/Municipality) of

________________, personally appeared the following persons, with their respective
Community Tax Certificates as follows:
Name C.T.C. No. Date/Place Issued
1. _________________ _______________ _____________________
2. _________________ _______________ _____________________
3. _________________ _______________ _____________________

all known to me and to me known to be the same persons who executed the foregoing
instrument which they acknowledged to me to be their free and voluntary act and deed,
consisting of only __________ (____) page/s, including this page in which this
acknowledgment is written, duly signed by them and their instrumental witnesses on each
and every page hereof.

WITNESS MY HAND AND SEAL this _______________ at

_________________, Philippines.

NOTARY PUBLIC

Doc. No. _____

Page No. _____
Book No. _____
Series of _____

REPUBLIC OF THE PHILIPPINES

 Department of Labor & Employment
NATIONAL CAPITAL REGION

__________________,
Complainant/s
CASE NO. _______
-versus-

__________________,
Respondent/s
x---------------------------------x

QUITCLAIM AND RELEASE

COMES NOW the undersigned complainant(s) in the above entitled case

before this Office, respectfully state(s):

That for and in consideration of the sum of ________________

(₱_________) in settlement of my/our claim/s as financial assistance and/or
gratuitously given by my/our employer receipt of which is hereby acknowledge to
my/our complete and full satisfaction, I/we hereby release and discharge the
______________________________________________ and/or its officers from
any and all claims by way of wages, separation pay, overtime pay, differential pay,
or otherwise as maybe due me/us incident to my/our past employment with said
establishment. I/we hereby state further that I/we have no more claim, right or
action of whatsoever nature whether past, present or contingent against the said
respondent and/or its officers.

In view hereof, I/we hereby move for the dismissal of the above-entitled
case with prejudice.

IN WITNESS WHEREOF, I/we have hereunto set my/our hand/s this

_______ day of _____________ 20____ in ________________________,
Philippines.

_______________________ _______________________
Complainant Complainant
_______________________ _______________________
Complainant Complainant
______________________ _________________________
Complainant Complainant
PAID IN THE PRESENCE OF: ATTESTED BY:
________________________ ______________________

SUBSCRIBED AND SWORN to before me, this ________, by

_____________ who exhibited to me (his/her) Community Tax Certificate No.
_____________ issued at _______________, Philippines on ______________.

NOTARY PUBLIC

Doc. No. ______

Page No. ______
Book No. ______
Series of ______
(AFFIDAVIT OF LATE REGISTRATION OF MARRIAGE CONTRACT)

REPUBLIC OF THE PHILIPPINES)

Province of __________________) S.S.
City/Municipality of ___________)

JOINT AFFIDAVIT
We, _____________ and _________, both Filipinos of legal ages, and
residents of __________________, Philippines, having been duly sworn in
accordance with law, hereby depose and state:
1. That we know the person _____________ as the same has been a close
acquaintance for a long period of time;
2. That we know for a fact that ___________ and ______________ were
lawfully joined together on ____________ at ____________ in a marriage
ceremony solemnized by _________________;
3. That we are likewise aware that the date of marriage appearing in the
Certificate of Live Birth issued for their child, ___________, is not the true
and correct one as they have not yet taken each as husband and wife at the
time of his birth;
4. That it was discovered but recently when ____________ requested for a
copy of their Marriage Contract from the Civil Registrar that the said
document has not yet been registered probably through oversight and so the
said Marriage Contract was only registered last ______________;
5. As such, we execute this affidavit to certify or attest to the truth of the
foregoing circumstances and for whatever legal purposes that this affidavit
may serve.

IN WITNESS WHEREOF, we have set our hands this ________________,

in __________________, Philippines.

____________________ ______________________
AFFIANT AFFIANT

SUBSCRIBED AND SWORN to before me, this ________, by

_____________ who exhibited to me (his/her) Community Tax Certificate No.
_____________ issued at _______________, Philippines on ______________.

NOTARY PUBLIC

Doc. No. ______

Page No. ______
Book No. ______
Series of ______
(Affidavit of Death Due to Vehicle Accident for Insurance Claim)

REPUBLIC OF THE PHILIPPINES)

Province of ___________________) S.S.
City/Municipality of ____________)

AFFIDAVIT

I, _______________, legal age, widow and a resident of _____________,

Philippines, after having been duly sworn to in accordance with law, do hereby
depose and state the following:
1. That I am the (widows/widower) of ___________________;
2. That my (husband/wife) died on ___________________, because of
_____________ injuries sustained in a vehicular accident as per the results
of the autopsy conducted by Dr. _______________________;
3. That per investigation of the _______________ Police Station, my
(husband/wife) died as a result of a vehicular accident at ___________ when
while he was ________________, he was bumped/hit by a truck coming
from the opposite direction;
4. That my husband was a duly licensed driver at the time of the incident and
was carrying Driver’s License No. _________________ and was riding on a
_________________ in color and with Plate No. ______________ owned
by ________________ with Certificate of Registration No.
______________;
5. That I am executing this affidavit to attest to the truth of the foregoing and
for whatever legal purposes that this statement may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

______________________, in ______________.

_____________________
AFFIANT

SUBSCRIBED AND SWORN to before me, this ________, by

_____________ who exhibited to me (his/her) Community Tax Certificate No.
_____________ issued at _______________, Philippines on ______________.

NOTARY PUBLIC

Doc. No. ______

Page No. ______
Book No. ______
Series of ______
(Affidavit to Establish the Birth of a Person for Late Registration with the
Civil Registrar)

REPUBLIC OF THE PHILIPPINES)

Province of ___________________) S.S.
City/Municipality of ____________)

AFFIDAVIT
I, Dr. ____________________, Filipino, of legal age,
(single/married/widow), and a resident of _______________, Philippines. Having
been duly sworn in accordance with law, hereby depose and state:

1. That I am duly-licensed medical doctor, practicing at ______________

(Hospital/Clinic) with Professional License No. _______________ issued on
___________ at _________________.
2. That on or about (time) of (date), I personally attended to a patient named
________________ in giving birth by (normal delivery/ caesarian section)
to a baby (boy/girl) whom they names as __________________;
3. That I execute this Affidavit to attest to the truth of the foregoing
circumstances and for any other legal purpose that this Affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

___________________, at ___________________, Philippines.

____________________
AFFIANT

SUBSCRIBED AND SWORN to before me, this ________, by

_____________ who exhibited to me (his/her) Community Tax Certificate No.
_____________ issued at _______________, Philippines on ______________.

NOTARY PUBLIC

Doc. No. ______

Page No. ______
Book No. ______
Series of ______
REPUBLIC OF THE PHILIPPINES)
Province of ___________________) S.S.
City/Municipality of ____________)

PRE-NUPTIAL AGREEMENT

KNOW ALL MEN BY THESE PRESENTS:

This PRE-NUPTIAL AGREEMENT, entered into this ________ day of

__________, ______, by and between _______________, of legal age and a resident of
______________, and _________________, also of legal age and resident of
_______________, WITNESSETH:

THAT the parties hereto are about to enter into a contract of marriage, tentatively
to take place on _____________;
THAT they hereby mutually agree that their property relations as future spouses
shall be under the regime of COMPLETE SEPARATION OF PROPERTIES during the
marriage;
THAT all the property, real and personal, now owned or hereafter to be owned by
the future wife ________________, shall remain to be her own exclusive and separate
property, subject to her sole disposition, administration and enjoyment , while those of
the future husband, _____________, shall likewise remain to be his own absolute
ownership, disposition and administration;
THAT all the earnings from any profession, business or industry shall likewise
belong to each future husband and wife;
THAT ___________________ (specify other stipulations);
THAT this agreement shall take effect upon the celebration of the marriage.

IN WITNESS WHEREOF, the parties have signed their names unto this document
this _______ day of ___________, 20___, the City/Municipality _______________.

_____________________ _____________________
Future Husband Future Wife

SIGNED IN THE PRESENCE OF: _______________________

SUBSCRIBED AND SWORN to before me, this ________, by _____________

who exhibited to me (his/her) Community Tax Certificate No. _____________ issued at
_______________, Philippines on ______________.

NOTARY PUBLIC

Doc. No. ______

Page No. ______
Book No. ______
Series of ______
REPUBLIC OF THE PHILIPPINES)
Province of ___________________) S.S.
City/Municipality ______________)

AFFIDAVIT OF WARRANTY

1. That I am the actual buyer of that motor vehicle which is specifically

described as follows:
MAKE TYPE
MODEL COLOR
MOTOR NO. CHASSIS NO.
2. That the fact of purchase is evidenced by that Deed of Sale of Motor Vehicle
dated ______________ whereby Mr./Ms. ______________ is the vendor
and I am the vendee as entered in the notarial register of Notary Public
____________ as Doc. No. _____; Page No. _____; Book No. ____; Series
of ____, a copy of said Deed of Sale is hereby attached for reference;
3. That I hereby attest to the authenticity of said Deed of Sale and the
genuineness of the transaction and in furtherance thereof, I hereby release
the officers and staff of the Land Transportation Office from any liability
which may occur in the event that there is any flaw or legal infirmities in
said transaction;
4. That I am executing this affidavit in order to attest to the veracity of the
foregoing circumstances and as a warranty on the authenticity and
genuineness of the above mentioned transaction.

IN WITNESS WHEREOF, I have set my hand this ____________ day of

__________, _____ at _______________________.

___________________
Signature of Affiant

SUBSCRIBED AND SWORN to before me, this ________, by

_____________ who exhibited to me (his/her) Community Tax Certificate No.
_____________ issued at _______________, Philippines on ______________.

NOTARY PUBLIC

Doc. No. ______

Page No. ______
Book No. ______
Series of ______
REPUBLIC OF THE PHILIPPINES)
Province of __________________) S.S.
City/Municipality of ___________)

AFFIDAVIT OF NO IMPROVEMENT

1. That I am the registered owner of that parcel of land located at Barangay

Bancal, Municipality of San Carlos, Pampanga which contains an area of
FIVE HUNDRED (500) HECTARES and is covered by Transfer Certificate
Title No. ______________ of the Registry of Deeds of Pampanga and is
now the subject of a Deed of Sale in favor of ______________;
2. That the above parcel of land is not planted to any tree or crops and has no
improvement contemplated by the Agrarian Reform Law;
3. That I am executing this affidavit in order to attest to the truth of the
foregoing circumstances and for the purpose of compliance with the
requirements of the Agrarian Reform Law.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of

____________ at _________________.

____________________
Signature of Affiant

SUBSCRIBED AND SWORN to before me, this ________, by

_____________ who exhibited to me (his/her) Community Tax Certificate No.
_____________ issued at _______________, Philippines on ______________.

NOTARY PUBLIC

Doc. No. ______

Page No. ______
Book No. ______
Series of ______
REPUBLIC OF THE PHILIPPINES)
Province of ___________________) S.S.
City/Municipality_______________)

AFFIDAVIT OF GUARDIANSHIP

1. That I am the father of my daughter _____________ by my deceased wife,

who died on ____________;
2. That by reason of the death of my above-named wife, I henceforth become
the father and guardian of my said daughter as she is still a minor having
been born on ______________;
3. That I am executing this affidavit in order to attest to the truth of the
foregoing circumstances and for the purpose of securing an educational
insurance for my said daughter in my capacity as her guardian.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of

____________, at __________________, Philippines

____________________
Signature of Affiant

SUBSCRIBED AND SWORN to before me, this ________, by

_____________ who exhibited to me (his/her) Community Tax Certificate No.
_____________ issued at _______________, Philippines on ______________.

NOTARY PUBLIC

Doc. No. ______

Page No. ______
Book No. ______
Series of ______
(Affidavit of Consent to Adoption by Parent)
REPUBLIC OF THE PHILIPPINES)
Province of ___________________) S.S.
City/Municipality of ____________)

AFFIDAVIT OF CONSENT TO ADOPTION

That I, ERYN GRACE MELLIZA LAFORTEZA, 15 years old, and

residing at U-42 Colonnade Residences, Legaspi Street, Legaspi Village, Makati
City, after having been sworn to in accordance with law, hereby state:

That I hereby give my full and voluntary consent to be adopted by my

natural and biological parents, ELIGIO AND MARILOU LAFORTEZA, who are
taking good care and supporting all my needs;

That I have been living with my said father and mother since my birth and
until they got married and up to the present and that since their marriage, to the
best of my knowledge, my said parents have been responsible for providing all my
expenses in school and for supporting all my needs and I have learned to love them
as my real father and mother as they have shown parental love and care, devotion
and concern for me;

That I love and accept both of them just like they are my parents as they
really are, except only for the fact that they were not married at the time I was
conceived and born, this fact never really pose any problem nor hindrance in our
true relationship as parents and child.

IN WITNESS WHEREOF, I have signed this document on this

___________ day of ______________________.

ERYN GRACE MELLIZA LAFORTEZA

AFFIANT

SUBSCRIBED AND SWORN to before me, this ________, by

_____________ who exhibited to me (his/her) Community Tax Certificate No.
_____________ issued at _______________, Philippines on ______________.

NOTARY PUBLIC
Doc. No. ______
Page No. ______
Book No. ______
Series of ______
(Affidavit of Consent to Adoption by Minor)
REPUBLIC OF THE PHILIPPINES
REGIONAL TRIAL COURT
NATIONAL CAPITAL JUDICIAL REGION
MAKATI CITY, BRANCH _______

IN THE MATTER OF ADOPTION OF MINOR

ERYN GRACE MELLIZA LAFORTEZA,

SPECIAL PROCEEDINGS NO.____

Re: Adoption
ELIGIO G. LAFORTEZA and
MARILOU M. LAFORTEZA,
Petitioners.
x----------------------------------x

PETITION

COME NOW petitioners, by the undersigned counsel, and to this Honorable

Court, most respectfully state and allege as follows:
1. That the petitioners, of legal age, Filipino citizens and presently residing at
U-42 Colonnade Res., Legaspi Street, Legaspi Village, Makati City, are the
father and mother of the adopted Eryn Grace Melliza Laforteza;
2. That said adoptee was born on January 23, 1989 in Makati City, copy of her
Certificate of Live Birth is hereto attached as Annex “A” and made an
integral part hereof;
3. That the said minor, Eryn Grace M. Laforteza, was born outside of wedlock
of her biological parents and, and therefore is an __________________
petitioner Eligio Laforteza was still married to another woman and it was
only on March 2, 2001, when petitioner Eligio was already a widower, that
their marriage was solemnized by Hon. Ignacio Capulong, Presiding Judge
of the Regional Trial Court of Makati City, Branch 134, a copy of their
Certificate of Marriage is hereto attached and marked as Annex “B” of this
petition;
4. That the minor herself, Eryn Grace Laforteza, now 15 years old have given
her full and voluntary consent to this adoption as shown by the Affidavit
executed and signed by her which is hereto attached and marked as Annex
“C” of this petition;
5. That in the Certificate of Live Birth of the minor Eryn Grace Laforteza, it
was indicated that her biological parents got married in Melbourne, Australia
on August 2, 1987 although the truth of the matter is that there was no such
marriage and the information was only given in good faith by the petitioners
 in their highest desire to make it appear that Eryn Grace Laforteza was
legitimate and should carry the name of her father;
6. That petitioners, as herein minor’s biological parents, have since her birth
both cared for, loved, reared and supported the said minor up to the present
as is naturally expected from normal biological parents, and, hence, in their
desire to adopt Eryn Grace, if only to improve her status to that of a
legitimate child, will give her proper care, good, decent and honorable future
to formalize their existing parent-child relationship and to serve the best
interest of the child. The said minor, being such and under the parental care
of petitioners, do not own any property of value. Under the above
circumstances, the requirement of trial custody period may be dispensed
with;
7. Petitioners possess all the qualifications and none of the disqualifications
necessary for adoption. They are in possession of full legal capacity and
legal rights and of good moral character and have not been convicted of any
crime involving moral turpitude and emotionally and psychologically
capable of carrying for children. They are also capable to give the said minor
the proper care, support, custody and parental love which they have always
bestowed to her oblivious of the legal abnormality in her societal status;
8. That petitioner Eligio, although retired his bank deposits with Air Materiel
Wing Savings ______________________ square meter lot at the exclusive
Valle Verde 6 Subdivision in Pasig City worth about ₱30,000,000.00 and a
house and lot consisting of 400 square meters at Teachers Village in Quezon
City worth about ₱10,000,000.00, copies of said bank certification and title
to the Valle Verde 6 and Teachers Village property are hereto attached and
marked Annexes “D”, “E” and “F”, respectfully;
9. That petitioner Marilou as a housewide, also has in her name a bank deposit
worth ₱3,000,000.00 at the Air Material Wing Savings and Loan
Association, Inc. and peso and dollar deposits of about ₱90,000.00,
respectively, at Metropolitan Bank and Trust Company, Perea-Gallardo
Branch in Makati City, copy of said certifications are hereto attached and
marked as Annexes “G”, “H” and “H1”, respectively;
10.That in compliance with the law, the consent to this adoption have been
obtained.

PRAYER

WHEREFORE, it is most respectfully prayed of this Honorable Court that

the trial custody period requirement be issued by this Honorable Court declaring
ERYN GRACE MELLIZA LAFORTEZA as adopted child of petitioners with the
reciprocal rights and obligations arising from a relationship of parents and child,
including the rights of said minor to carry the name ERYN GRACE MELLIZA
LAFORTEZA which she has always carried since her birth but now heretofore
etched with legal function.

PETITIONERS further pray for such other relief as maybe just and equitable
in the premises.

____(place)__________, _____(date)________.

FERNANDO B. DUQUE
Counsel for the Petitioners
Unit 2102 Regency at Salcedo
Tordesillas St., Salcedo Village
Makati City
Roll No. 16838: IBP No. 573755
PTR No. 4421219; 1/6/04; Malabon

VERIFICATION AND CERTIFICATION

 OF NON-FORUM SHOPPING

REPUBLIC OF THE PHILIPPINES)

Province of __________________) S.S.
City/Municipality of ___________)

I, ___________________, of legal age, Filipino, (single/married/widow),

and a resident of ___________________, Philippines, after being sworn in
accordance with law, hereby depose and say:

That I am the (Plaintiff/Complaint/Petitioner) in the above-entitled case;

That I have caused the preparation of the above (Complaint/Petition) and I have
read the same and knows the contents thereof; That the allegations contained
therein are true and correct of my own personal knowledge.

That I further certify that: (a) I have not therefore commenced any other
action or proceeding or filed any claim involving the same issues or matter in any
court, tribunal, or quasi-judicial agency and, to the best of my knowledge , no such
action or proceeding is pending therein; (b) if I should thereafter learn that the
same or similar action or proceeding has been filed or is pending before the
Supreme Court, the Court Appeals, or any other tribunal or quasi-judicial agency, I
undertake to report such fact within five (5) days therefrom to the court or agency
wherein have been filed.

IN WITNESS WHEREOF, I have hereunto set my hand this

_____________________, at _______________, Philippines.

________________________
AFFIANT

SUBSCRIBED AND SWORN to before me, this _____________, by

___________ who exhibited to me (his/her) Community Tax Certificate No.
_____________ issued at _______________, Philippines on _______________.

NOTRARY PUBLIC

Doc. No. ______

Page No. ______
Book No. ______
Series of ______
REPUBLIC OF THE PHILIPPINES)
Province of ___________________) S.S.
City/Municipality of ____________)

PROMISSORY NOTE

₱_____________

FOR VALUE RECEIVED, I promise to pay to the order of

______________ the sum of (in words) (₱___________), Philippine Currency, on
or before _______________, at his residence/office at ______________. Failure
on my part to comply with this promise on the date aforementioned shall subject
the above principal to interest at the rate of _____ % per month and should the
collection be made with the services of a lawyer, then the same shall further be
subject to 20% attorney’s fees. In the event that a case for collection of the sum of
money above stated be filed, the principal shall earn further interest at the rate of
____%, plus cost of suit and other expenses.

October ________, 20___ at ___________________, Philippines.

_________________
Signature of Maker

REPUBLIC OF THE PHILIPPINES)

Province of __________________) S.S.
City/Municipality of ___________)

CONTRACT OF GUARD SERVICES

KNOW ALL MEN BY THESE PRESENTS:

This contract made and executed this _____________________ at

_____________ by and between:

VASSAR INDUSTRIES, INC. a corporation duly organized and under by

virtue of the laws of the Republic of the Philippines Makati, Metro Manila duly
represented herein by its President, Mr. Antonio F. Chua, hereinafter referred to as
“CLIENT”.

-and-

JAGUAR SECURITY & INVESTIGATION AGENCY a corporation duly

organized and existing under the virtues of the laws of the Republic of the
Philippines with business address at David Building I, 567 Shaw Boulevard,
Mandaluyong, Metro Manila, duly represented by its Executive Director, Cesar
Bengzon Poe, hereinafter referred to as “SECURITY COMPANY”, as evidenced
by its duly approved Board Resolution thereto attached as Annex “A” of this
contract.

-WITNESSETH that-

WHEREAS, the CLIENT, desires to engage the services of the SECURITY

COMPANY for the purpose of maintaining law and order at its premises located at
7272 Malugay Street and Yakal Street Makati, Metro Manila by protecting and
guarding its property from all forms of criminality and irregularities but not limited
of theft, robbery, arson destruction or damage as well as protecting its officers,
employees, visitors and regulations relative to maintenance of security and safety
threat. Copy of the CLIENT’s premises covered by this thereto attached as Annex
“B”.

WHEREAS, the SECURITY COMPANY is a duly licensed and bonded

security agency operating under the provisions of Republic Act No. 5487 as
amended, registered and accredited with PNP-Susia, Camp Crame, Q.C.
 NOW, THEREFORE, for and in consideration of the foregoing premises of
the mutual covenants and provisions hereafter set forth the parties hereto have
agreed and do hereby mutually agree as follows:

1. Place and Location

The SECURITY COMPANY shall provide security guard and services to

the CLIENT at its premises located at 7272 Malugay Street, Makati, Metro Manila.

2. Functions and Duties of Guards

The guards are to maintain general peace and order at the aforementioned
premises and specifically, to watch, safeguard and protect the property of the
CLIENT from theft, robbery, arson and destruction or damages, to protect the
directors, officers, harassment, threat or intimidation; and to enforce and
implement rules, policies and regulations of the CLIENT aimed at maintaining
security and safety thereat.

3. Guard Forces

The SECURITY COMPANY shall initially provide the CLIENT with the
necessary number of duly qualified and licensed Security Guards, which must first
be re-approved by the CLIENT, who shall each render twelve (12) hours work per
day at Ten Thousand Four Hundred Ninety One and 95/100 (₱10,491.95) per
guard (12 hours duty).

The number of contracted and detailed guards may be increased or decreased at

any time on written request of CLIENT.

Please refer to Annex “C” for the actual number of Security Guards needed at
the time of the signing of this contract.

4. Qualification of Guards

Each of the security guards to be assigned by the SECURITY COMPANY to

the client must be:
a. of good moral character and reputation, courteous, alert and without criminal
or police record;
b. physically and mentally fit and not less than 21 nor more than 40 years of
age and at least five feet four inches (5’4”) in height;
c. duly licensed and properly screened and cleared by the P.N.P., N.B.I. and
other government offices issuing clearances for employment;
 d. in proper uniform and must have other security paraphernalia such as
flashlight, radio, night stick, etc. armed with appropriate and functional rifle,
shotgun, pistol or revolver, with sufficient ammunition at all times during
hours of duty;
e. must have passed the neuro-psychiatric exam; and
f. in possession of such other qualifications required by Republic Act No. 5487
as amended.

The CLIENT must be furnished copy of license and result of exam mentioned
under c) and e) above.

5. Mode of Payment