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AFFIDAVIT for PERSONAL USE

I, ESMAEL C. CODILLA, a Filipino citizen, 55 yrs of age, married to NECITAS M


CODILLA, and a resident of Ybanez Compound, Brgy. Mambaling, Cebu City, after having been
duly sworn in accordance with law, hereby depose and say:

1. That I am the shipper of the following items listed below.

2. That the Items listed (Indicated Product Name, Lot No., Batch No., Registration No.,
Expiry Date) are certified true and correct.

2a. ITEMIZED LIST OF PRODUCTS

Medicom (Dry-Back) Dental Bibs 2 plys of tissue + 1 ply poly 1 pack


Ponds White Beauty - Product No. 20260833 3 pcs.

Masareal (Expiry Date July 27, 2016) 6 pcs.


Pinasugbo (Expiry Date January 11, 2017) 6 pcs.
Piyaya (Expiry Date August 28, 2016) 2 pcs.
Piato (Expiry Date October 30, 2016 6 pcs.
Dried Mangoes Mangue Seche (Expiry Date June 30, 2018 2 pcs.
Dried Mangoes R & M (Expiry Date May 6, 2017) 2 pcs.
Rosquillos Snack Pack REG. PAT. OFF. NO. SR. 247
(Expiry Date March 08, 2017 1 pc.
Galletas De Carmen ( Expiry Date December 08, 2016) 1 pc.
Galletas De Bato ( Expiry Date October 08, 2016) 2 pcs.
Goldilocks Classic Polvoron Lot No. 179162064, 179162134
(Expiry Date September 20, 2016) 2 pcs.
Pasetel Buns with filling (Manufacture Date July, 25,2016 1 pc.
Dried Fish (packed and sealed) - *Dangit 8 packs
*Bolinao 3 packs
*Squid 3 packs

3. That the consignee, Mrs. Maria Elena C. Steele of legal age a resident of 900 Palm
Ave. Apt. 18, National City, California 91950, USA is the authorized claimant of the
listed items above and it is for personal usage/consumption and not for commercial
purposes.

4. That I am executing this affidavit for whatever legal purposes it may serve.

Further Affiant sayeth none.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 10th day of August
, 2016 in Cebu, City Philippines.

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(Signature of Affiant over Printed Name)
SUBSCRIBED AND SWORN before me this........ day of ........................... 20__,
by ............................................. who exhibited to me his CTC No. ...................................
issued on ................................. at ...........................................

Notary Public

Doc. No. .........:

Page No. .........;

Book No. .........;

Series of 20__.