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Naga City...) S.S.


WE, __________________, both of legal age, Filipino, single (living together) and
residents of _________________, after having been duly sworn in accordance with law,
depose and state that:

1. We have been living together as husband and wife under the same roof,
continuously and without any interruption, since 2010 or a period of more than five
(5) years;

2. During our cohabitation and even until the present, we remain both of single
status and, hence, there exists no legal impediment for us to marry each other;

3. We were blessed with four (4) children namely:

_____________ born on ______________

_____________ born on ______________
_____________ born on ______________
_____________ born on ______________;

4. We are executing this affidavit to attest to the foregoing facts and for the
purposes of contracting marriage without the need of securing the marriage
license pursuant to the provisions of Article 34 of the Family Code of the

IN WITNESS WHEREOF, we have hereunto set our hands this 11th of October
2017 in Naga City, Philippines.

__________________ _____________________
Affiant Affiant
VIN: ____________________ VIN: _______________

SUBCRIBED AND SWORN TO, before me this October 11, 2017 in Naga
City, Philippines, after affiants exhibited to me their valid proofs of identification.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2017.