<p> FORM NO. CMD-CapAlloc-01</p><p>AFFIDAVIT OF CAPACITY AND ENERGY ALLOCATIONS BY DISTRIBUTION UTILITY (DU)</p><p>REPUBLIC OF THE PHILIPPINES } CITY OF ______} SS</p><p>I, ______, of legal age, single/married, residing at ______, for and in behalf of ______, after being sworn in accordance with law, (Name of DU) depose and say, That:</p><p>I am the General Manager of ______; (Name of DU)</p><p>I attest to the fact that our company is complying and will continue to comply with the provisions and requirements for a DU as embodied in Resolution No. 5, Series of 2013 entitled “A Resolution on Disclosures of Capacity and Energy Allocations by Distribution Utilities in the Luzon and Visayas Grids and Retail Electricity Suppliers.” </p><p>A. The following are the capacity and energy (in MW and MWh) that our company has contracted with Generation Companies (including Independent Power Producer Administrators), purchased from the Wholesale Electricity Spot Market, or generated for the (1st, 2nd, 3rd, 4th) Quarter of 201__:</p><p>Affiliate Non-Affiliate Contracted Contracted Contracted Contracted Capacity Energy Capacity Energy (MW) (MWh) (MW) (MWh) From Bilateral Contracts</p><p>Name of Generation Company A Name of Generation Company B Name of Generation Company C</p><p>WESM Purchases Embedded Generation, if any Total (use additional sheet if necessary)</p><p>B. The following are the capacity and energy (in MW and MWh) that our company has allocated to our business segments for the (1st, 2nd, 3rd, 4th) Quarter of 201__:</p><p>Regulated Supply Non-Regulated Supply Last Resort Supply Business Segment Business Segment Business Segment (Captive Customers) (Local RES Customers); (SOLR Customers); if applicable if applicable Capacity Energy Capacity Energy Capacity Energy (MW) (MWh) (MW) (MWh) (MW) (MWh)</p><p>(use additional sheet if necessary)</p><p>I further swear or affirm that all statements made in this affidavit are true, correct and complete and that any changes in such information will be provided to the Energy Regulatory Commission in a timely manner. </p><p>FORM NO. CMD-CapAlloc-01</p><p>IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of ______, 201__, in the City of ______, Philippines.</p><p>______(Signature of affiant)</p><p>SUBSCRIBED and sworn to before me, in the City of ______, this ______day of ______, 201__ by ______with Community Tax Certificate No. ______issued at ______on ______, 201__.</p><p>NOTARY PUBLIC Until December 31, 201__ Doc. No. _____; Page No. _____; Book No. _____; Series of 201___</p><p> cmd/datl/fscj</p>