REPUBLIC OF THE PHILIPPINES )

CITY OF _________________ ) S.S.

x------------------------------------x

JOINT AFFIDAVIT OF COHABITATION

WE, __________________ and __________________, both of legal age,

Filipino, single, living together and residents of __________________, after having
been duly sworn to 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 Year __________________ or a period of
__________________ years more or less;

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

3. We were blessed with two sons namely __________________ and

__________________ who were born on __________________ and
__________________, respectively in Iloilo City;

4. We are executing this affidavit to attest to the foregoing facts and for the purposes of
__________________.

IN WITNESS WHEREOF, we have hereunto set our hands

this ___________________in the City of __________________, Philippines.

Affiant Affiant

SUBCRIBED AND SWORN TO before me this ___________________ in

the City of Iloilo, Philippines, affiants exhibiting to me their valid proofs of identification
which is a __________________.

Doc. No. _____;

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