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MGB Form No.

12-3

REPUBLIC OF THE PHILIPPINES

Municipality of ______________
Province of __________________

AFFIDAVIT OF WITNESS

I, _____________________________________, of legal age and a resident of

_______________________________________, after being duly sworn, depose and
state:

1. That on or about ___________________________________________ I was at

2. That on or about said time and date , I saw _________________________________

____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________.

3. That I am executing this affidavit to attest to the truth of the foregoing narration.

IN WITNESS WHEREOF, I have hereto signed this affidavit this ____________

day of ____________________ , 19 _____ at ______________________________ .

_______________________
Affiant
TIN _______________

ACKNOWLEDGEMENT

Republic of the Philippines _____ )

Province of ________________ ) S. S.
City/Municipality of _________ )

SUBSCRIBED AND SWORN to before me at the place aforesaid, on this

__________ day of ____________________, 19_____. The affiant exhibited to me
his/her Community Tax Certificate No. ____________ issued at ___________ on the
___________ day of _______________, 19____.

___________________________
NOTARY PUBLIC
Until Dec. 31, 19 ______
PTR No. ____________
Doc. No. _______
Page No. _______
Book No. _______
Series of _______

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mgbform12-3

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mgbform12-3

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MGB Form No.

REPUBLIC OF THE PHILIPPINES

I, _____________________________________, of legal age and a resident of

1. That on or about ___________________________________________ I was at

2. That on or about said time and date , I saw _________________________________

IN WITNESS WHEREOF, I have hereto signed this affidavit this ____________

Republic of the Philippines _____ )

SUBSCRIBED AND SWORN to before me at the place aforesaid, on this

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