Jurat for an Individual Affiant

(Jurat for an Individual 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 ______;