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    Blank Affidavit of Income Declaration

    Uploaded by

    Jemmie Rose
    The document is an affidavit of income declaration from an individual residing in Brgy. Sto. Cristo, Guimba, Nueva Ecija. In the affidavit, the individual declares that they work as [job title blank], receive [monthly income blank] per month, and are submitting the affidavit as a requirement for PhilHealth and for any legal purposes. The affidavit was signed on January 11, 2020 in Cuyapo, Nueva Ecija.

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    Blank Affidavit of Income Declaration

    Uploaded by

    Jemmie Rose
    208 views1 page
    The document is an affidavit of income declaration from an individual residing in Brgy. Sto. Cristo, Guimba, Nueva Ecija. In the affidavit, the individual declares that they work as [job title blank], receive [monthly income blank] per month, and are submitting the affidavit as a requirement for PhilHealth and for any legal purposes. The affidavit was signed on January 11, 2020 in Cuyapo, Nueva Ecija.

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    The document is an affidavit of income declaration from an individual residing in Brgy. Sto. Cristo, Guimba, Nueva Ecija. In the affidavit, the individual declares that they work as [job title blank], receive [monthly income blank] per month, and are submitting the affidavit as a requirement for PhilHealth and for any legal purposes. The affidavit was signed on January 11, 2020 in Cuyapo, Nueva Ecija.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    208 views1 page

    Blank Affidavit of Income Declaration

    Uploaded by

    Jemmie Rose
    The document is an affidavit of income declaration from an individual residing in Brgy. Sto. Cristo, Guimba, Nueva Ecija. In the affidavit, the individual declares that they work as [job title blank], receive [monthly income blank] per month, and are submitting the affidavit as a requirement for PhilHealth and for any legal purposes. The affidavit was signed on January 11, 2020 in Cuyapo, Nueva Ecija.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 1

    Republic of the Philippines)

    Province of Nueva Ecija…..)S.S.


    Municipality of Cuyapo……)

    AFFIDAVIT OF INCOME DECLARATION

    I, _______________________, of legal age, married, and a resident of Brgy. Sto.


    Cristo, Guimba, Nueva Ecija, under oath, hereby depose and state:

    1. That I am currently working as _________________________________;


    2. As such, I am receiving only _________________________ a month;
    3. That I am executing this Affidavit of Income Declaration as a PhilHealth
    requirement and for all legal purposes it may serve.

    In witness whereof, I hereunto set my hand this 11 th day of January, 2020 in


    Cuyapo, Nueva Ecija.

    _____________________________________
    Affiant

    Subscribed and sworn to before me this 11th day of January 2020 in the
    Municipality of Cuyapo, Nueva Ecija, affiant exhibiting his ID
    _________________________.

    NOTARY PUBLIC

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