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REPUBLIC OF THE PHILIPPINES )

PROVINCE OF ZAMBOANGA DEL NORTE ) S.S


x-------------------------------------------------------x

AFFIDAVIT OF OWNERSHIP

I, DARYLE SARITA, Filipino citizen, of legal age, married, a resident of Thomas Claudio St.,
Miputak, Dipolog City, after having duly sworn in accordance with law hereby depose and state that:

1. I am the owner of the following appliances:


a. 1 unit of Sanyo Freezer, Model SF-C24KP with a Serial No. 1411000207R

b. 1 unit of Samsung TV16 inches, Model CT-21Z45 with a Serial No. AGJA35ZLCO3852Y

c. 1 unit of Sharp colored TV, Model 14V-W70M with a serial No. 00970159

2. That I acquired and fully paid the following items, to wit:


a. TV Samsung 16 inches and Sharp Colored TV 14 inches from Better Living Appliances,
Dipolog City, and
b. SANYO FREEZER from IMPERIAL APPLIANCE, Gen. Luna St., Dipolog City.

3. That I am executing this affidavit of ownership to attest the truth and to support my application
for loan with the Katipunan Rural Bank, Dipolog City.

DARYLE SARITA
Affiant

IN WITNESS WHEREOF I have hereunto affixed my signature this ___________ day of June
2017 in Dipolog City.

SUBSCRIBED AND SWORN TO before me this ____________ day of June 2017 at Dipolog City,
Philippines.

Doc. No.___
Page No.___
Book No.__
Series of 2017

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