Affidavit of Potential Owner

REPUBLIC OF THE PHILIPPINES)

Taguig City, Philippines ) S.c.

AFFIDAVIT OF POTENTIAL OWNER

I, { }, of legal age, Filipino, widow, and with address at { }, Philippines, subscribing under oath, hereby depose that:

1. I am the wife of the late { } who died sometime in year { } in Taguig City.

2. { } is the grandson of { }. The latter died on { } leaving a parcel of land situated at { } covered by Tax Declaration No: { }.

3. At present, I am the potential owner of the said lot as heir of my late husband and I am currently residing in the said property.

4. I am the owner in the said property and processing my application for Electric Connection of the aforementioned property situated at { }, Philippines.

5. In view of thereof, I am executing this Affidavit of Potential Owner for Application of Electric Connection and to use the same for whatever legal purpose it may serve.

6. Affiant further sayeth naught.

IN WITNESS WHEREOF, I hereunto affix my signature this { } at Taguig City.

{ }

Affiant

SUBSCRIBED AND SWORN to before me, a Notary Public for and in Taguig

City personally appeared this { } at Taguig City, { }, who presented to me her { } ID No. { }, issued by { }, the same bearing affiant's photograph and signature, and who attested that he is the same person who personally signed before me the foregoing document and acknowledged that he executed the same.

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