Affidavit Of Acceptance Renon.docx

REPUBLIC OF THE PHILIPPINES } QUEZON CITY } S.S.

AFFIDAVIT OF ACCEPTANCE I, Efren R. Renon, Filipino, of legal age, married, and a resident of 115 Maria Clara St., Caloocan City , after having duly sworn to in accordance with law, hereby depose and say that: 1. That an agreement between the undersigned and Superb Security and Investigation Agency, Inc. had been made. 2. That I have accepted the amount of SIXTEEN THOUSAND TWO HUNDRED Pesos (P16,200.00) from SUPERB SECURITY AND INVESTIGATION AGENCY INC., for the Payment of my monthly Premium contributions to Philhealth from July 2008 to May 2015; 3. That in my own capacity, I will personally pay my PHILHEALTH monthly contribution and in return I will give the PHILHEALTH receipts to Superb Security and Investigation Agency, Inc. as my faithful compliance with the agreement; 4. That failure to return the said receipts will constrain Superb Security and Investigation Agency, Inc to file a Legal Action/Complaint against me to enforce the said Agreement; 5. I am executing this affidavit to attest to the foregoing facts; IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of June 2016 in Quezon City, Philippines. Efren Renon Affiant SUBSCRIBED AND SWORN to before me this ______ day of _____________ _______ in ____________________ Philippines, affiant having exhibited to me his/her issued by the Social Security System. NOTARY PUBLIC Doc. No.____; Page No.____; Book No.____; Series of 2016.