Affidavit Of Income Philhealth - John Paul B. Cagape

REPUBLIC OF THE PHILIPPINES) CITY OF TAGBILARAN )S.S. X- - - - - - - - - - - - - / AFFIDAVIT OF INCOME DECLARATION I, JOHN PAUL B. CAGAPE, Filipino, of legal age, married, and a resident of Manga, Tagbilaran City, Bohol, Philippines, after having sworn in accordance with law, depose and say that: 1.

I am intending to be member of the Philippine Health Insurance Corporation;

2.

I have not been gainfully employed and not engaged in the operation of any business, thus I am not generating any income;

3.

I rely on my parents for support and sustenance;

4.

I am executing this Affidavit-Declaration to comply with the PhilHealth requirement in the determination of the applicable premium bracket to be imposed by them and for all legal purposes this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 21 st day of January 2020 in the City of Tagbilaran, Province of Bohol, Philippines.

JOHN PAUL B. CAGAPE Affiant-Declarant Police Clearance No. 25254063 Issued by: Philippine National Police Issued on: 1/16/2020 SUBSCRIBED AND SWORN TO BEFORE ME, this 21 st day of January, 2020, in the City of Tagbilaran, Province of Bohol, Philippines.

ATTY. JOHN JERIC S. LIM NOTARY PUBLIC COMM UNTIL DEC. 31, 2021 Attorney’s Roll No. 70690 IBP No. 095579 for 2020 PTR No. 7940547 for 2020 TIN No. 278608672 NCS No. 2020-21