Republic of the Philippines )

Province of ___________ ) S.S.

City of ____
)
x------------------------------------x

COUNTER-AFFIDAVIT

I,
of legal age, sing/marr, Filipino and a resident of , after having
duly sworn to in accordance with law, depose and say:
1. That I am executing this counter-affidavit as a reply and
comment to

IN WITNESS WHEREOF, I hereunto affixed my signature this __ day

of December 2014 at.

___________
Affiant
SUBSCRIBED AND SWORN to before me this ____ day of
December 2014 at.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2014.