Republic of the Philippines)

Province of )S.S.

AFFIDAVIT OF SERVICE

I, _________________________, of legal age, married, and a resident of

_____________________, after having been duly sworn in accordance with law,
hereby depose and say:

That I am an _________________________ of the Provincial Legal Office under the

Provincial Government of Tarlac;

That in my aforementioned capacity, I had personally served a copy of the

_____________________ to ______________________ as received by
_________________________ on ____________________.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________ at

_____________, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me_______________, at __________________,

Tarlac, Philippines, Affiant exhibited to me his/her _______-ID No ___________- with
photograph.

Doc. No. _____

Book No. _____ Notary Public
Page No.______
Series of 2019