REPUBLIC OF THE PHILIPPINES)
______________________
)
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AFFIDAVIT
I, ________________, Filipino, of legal age, and a resident of Brgy. ____________
Philippines, after being duly sworn to in accordance with law, hereby depose and state:
That I am the same person executing this Affidavit;
That on or about the month of September 2010, __________ obtained several goods
from me on credit;
That on September 17, 2010, _______ made a partial payment of his loan but leaving a
balance of P 33, 152.00;
That despite his promise and even after several demands, ___________ failed to pay his
unpaid loan;
That brought the matter before the Punong Barangay for amicable settlement and again
he made a promise to pay. However, he again failed to comply with his promise;
As such, I am executing this Affidavit to attest to the truth of the foregoing and for the
purpose of filing a complaint against Juanito Eugenio for the collection of his unpaid
loan.
IN WITNESS WHEREOF, I have hereunto set my hand this _______________ at
________________, Philippines.
_____________________________
Affiant
SUBSCRIBED AND SWORN to before me, this _________________ at
______________ by the Affiant whom I have identified through competent evidence of identity.
WITNESS my hand and seal.