Republic of the Philippines)

Municipality of________________)SS

AFFIDAVIT OF BEING SINGLE

I, ____________________________, of legal age, Filipino, with residence address at Poblacion,

____________________________, ___________________after having been duly sworn to in accordance
with law, do hereby depose and say, that:

1. I have never contracted any marriage in the Philippines or elsewhere and I remain SINGLE to this
very day and hour;

2. I have no child born at the time of the execution of this Affidavit;

3. I am executing this Affidavit for the purpose of complying with the requirements in connection
to my application with _______________________________;

4. I declare that the statements made in this affidavit are true and correct and I am willing to bear
all the legal responsibilities arising therefrom.

IN WITNESS WHEREOF, I have hereunto set my hand this ___th day of ___________ 2019 at
_______________, ___________________, Philippines.

________________________________
Affiant

SUBSCRIBED AND SWORN TO before me this ___th day of June 2019 in _________________,
__________________, Philippines. Affiants exhibiting to me his Passport ID as competent evidence of her
identity.

Doc. No. _______

Page No. _______
Book No. _______
Series of 2019