Republic of the Philippines Province of Northern Samar S.S. Municipality of Catarman AFFIDAVIT I, ________, of legal age, single/married, ilipino citi!en, "ith residence address at ###############, under oath, depose and state that$ %. I "as el ected as a member of the Sangguniang &arangay of the barangay government of ############## for one term or from 'ecember %, ()%) and until November *), ()%*+ (. o the bes t of my -no "ledg e and base d on auth entic re cord s, I "as not employed in the gover nment "hatsoeve r during my tenure/term as member of the Sangguniang &arangay for one term or from 'ecember %, ()%) and until November *), ()%* in the government, CC0s or in any government instrumentality and I did not receive any salary/compensation e1cept my honorarium+ *. I can att est eac h and ever y fact menti oned in thi s aff ida vit bef ore any proceedings and that I shall be held liable for "hatever falsity+ 2. I am e1ecut ing thi s 3ff id av it to at te st to th e ve rac it y of th e fo re go ing facts and for th e pu rp os e of comp ly ing "i th th e re4uirements of barangay eligibility. IN WITNESS WHEREOF, I hereunto affi1 my signature this 5 th day of ctober ()%5 at Catarman, Northern Samar. ________ Affiant Proof of Identity : ________ SUBSCRIBED AND SWORN to before me this 5 th day of ctober ()%5 at Catarman, Northern Samar, affiant e1hibiting to me competent proof of identity, the details of "hich is sho"n belo" affiant0s name. 'oc. No. ####+ Page No. ####+ &oo- No. ####+ Series of ()%5.

Affidavit - Brgy Eligibility - Kagawad - Format

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Brgy Eligibility

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7/17/2019 Affidavit - Brgy Eligibility - Kagawad - Format

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Republic of the PhilippinesProvince of Northern Samar S.S.Municipality of Catarman

AFFIDAVIT

I, ________, of legal age, single/married, ilipino citi!en, "ithresidence address at ###############, under oath, depose and statethat$

%. I "as elected as a member of the Sangguniang &arangay of the barangay government of ############## for one term or from'ecember %, ()%) and until November *), ()%*+

(. o the best of my -no"ledge and based on authentic records, I "asnot employed in the government "hatsoever during my tenure/term as member of the Sangguniang &arangay for one termor from 'ecember %, ()%) and until November *), ()%* in thegovernment, CC0s or in any government instrumentality and Idid not receive any salary/compensation e1cept my honorarium+

*. I can attest each and every fact mentioned in this affidavit beforeany proceedings and that I shall be held liable for "hatever falsity+

2. I am e1ecuting this 3ffidavit to attest to the veracity of theforegoing facts and for the purpose of complying "ith there4uirements of barangay eligibility.

IN WITNESS WHEREOF, I hereunto affi1 my signature this 5 th

day of ctober ()%5 at Catarman, Northern Samar.

________

Affiant

Proof of Identity: ________

SUBSCRIBED AND SWORN to before me this 5th day of ctober()%5 at Catarman, Northern Samar, affiant e1hibiting to me competentproof of identity, the details of "hich is sho"n belo" affiant0s name.

'oc. No. ####+Page No. ####+

&oo- No. ####+Series of ()%5.