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Republic of the Philippines }

City of __________________ } S.S.

Republic of the Philippines }

City of __________________ } S.S.

Republic of the Philippines }

City of __________________ } S.S.

Republic of the Philippines }

City of __________________ } S.S.

Republic of the Philippines }

City of __________________ } S.S.

Republic of the Philippines }

City of __________________ } S.S.

Republic of the Philippines }

City of __________________ } S.S.

Republic of the Philippines }

City of __________________ } S.S.