AFFIDAVIT

I, _______________________, Filipino citizen, of legal age, single/married to

________________________________, and a resident of _______________________, after
having been duly sworn in accordance with law, hereby depose and say:

1. _______________________________________________________________________
_______________________________________________________________________
__________________________________________________________________

2. _______________________________________________________________________
_______________________________________________________________________
__________________________________________________________________

3. _______________________________________________________________________
_______________________________________________________________________
__________________________________________________________________

Further Affiant sayeth none.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ......... day of

....................., 20__in Dhaka, Bangladesh.

.......................................................................
(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN before me this........ day of ........................... 20__, by

............................................. who exhibited to me his Passport with No. ...................................
issued on ................................. at ...........................................

.......................................................................
Administering Officer

Doc. No.: ____________________

Service No.: ____________________
O.R. No.: ____________________
Fee Paid: ____________________