REPUBLIC OF THE PHILIPPINES )

CITY OF MAKATI ) S.S.

AFFIDAVIT OF ECONOMIC STATUS

(GREEN CARD)

I, _____________________, Filipino citizen, single, of legal age,

and residing at __________________________________Makati City, after
having been duly sworn to in accordance with law do hereby
deposes and states that;

1. I am applying for Green Card at Makati Medical Center,

Makati City, and in connection therewith, I am required to
submit a sworn statement of my economic status, hence this
affidavit;

2. I would like to state under oath that I am unemployed and

totally dependent for subsistence and support upon my father
_______________________________ who is an Employee, earning
Php _____________ a month;

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

foregoing facts and in order to inform the proper authorities
concerned for all legal intents and purposes this may serve.

AND FURTHER AFFIANT SAYETH NAUGHT.

_______________________
Affiant

SUBSCRIBED AND SWORN to before me this

___________________________ at Makati City, affiant exhibiting to me
his Professional Drivers License ID No._______________________.

Doc. No. ________

Page No. ________
Book No. ________
Series of 201_