Republic of the Philippines)

City
of Kabankalan
) S.S.
x----------------------------------x
AFFIDAVIT OF NO INCOME
I, HEDELIZA O. CAJERMAN, of legal age, married, Filipino and a resident of
Purok 2, Brgy. Bantayan, Kabankalan City, Negros Occidental, after having been duly
sworn to in accordance with law, do hereby depose and say:
1. That I am the registered owner of Greenland Lying-in and Birthing Center
with business address at Purok 2, Brgy. Bantayan, Kabankalan City, Negros
Occidental;
2. That it was registered for accreditation last October 2013 before the Office
of Philhealth;
3. That I have applied for a business permit before the Office of the Mayor,
Kabankalan City also last October 2013 and the same is still pending
approval;
4. That the birthing center have not yet operated pending the approval of my
Philhealth accreditation application and business permit application, hence,
the same have not yet generated any income since October 2013 up to the
present;
5. That I am executing this Affidavit to prove the foregoing facts and for
whatever legal purpose it may serve.
IN WITNESS WHEREOF, I have hereunto affixed my hand, this 2 nd day of
January, 2014 at the City of Kabankalan, Negros Occidental
HEDELIZA O CAJERMAN
Affiant
CTC No. 17123742
Issued on January 2, 2014
At Brgy. Bantayan, Kabankalan City
Philhealth 3000-1327272-0
SUBSCRIBED AND SWORN to before me this 2 nd day of January, 2014 at
the City of Kabankalan, Negros Occidental.