Affidavit of Service-Sample Form

Republic of the Philippines Province of Albay City of Tabaco

) ) s.s.

AFFIDAVIT OF FILING AND SERVICE

I, of legal age, Filipino, and a resident of  after having been duly sworn to in accordance with law hereby depose and say that: On

, I filed and served copies of the Comments by:

Registered Mail to:

 by depositing a copy thereof, in the post office of , as evidenced  by Registry Receipt No. __________ hereto attached and indicated after  the names of the addressee/s and with instructions to the post master to return the mail to the sender after ten (10) (10 ) days if undelivered. IN WITNESS WHEREOF, I have hereunto affixed my signature this at ___________, Philippines.

day of 

 __________________   __________________  Affiant

SUBSCRIBED AND SWORN TO BEFORE me this __ day of , Philippines.

at the