AFFIDAVIT OF ABANDONMENT

I, ____________________________________________________, Filipino citizen, of legal age,

single/married to _____________________________________________________, presently residing in the
Kingdom of Saudi Arabia, with postal address at
_________________________________________________________________ and with Philippine address at
_________________________________________________________________, after having been duly sworn
in accordance with law, hereby depose and say:

1. That I am married to/had a common-law relationship with Mr./Ms. ______________________

_____________________________________ in ___________________________________
from ______________________________________________________________________;

2. That out of the relationship was/were born the following child/children

a. ___________________________________________________________________
b. ___________________________________________________________________
c. ___________________________________________________________________

3. That my spouse/common law partner, Mr./Ms. _____________________________________,

abandoned me and my child/children in _______________________________ and since that
time has not communicated with us nor extended any financial support;

4. That I am executing this affidavit to attest to the truth of the foregoing facts, particularly, the
abandonment of my spouse/common-law partner.

FURTHER AFFIANT SAYETH NONE.

IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of ____________________
20____ at the Philippine Consulate General, Jeddah, Kingdom of Saudi Arabia.

__________________________
Signature of Affiant
Witnesses:

1. __________________________________ 2. __________________________________

x---------------------------------------------------------------------------------------------------------------------------------------------------x
FOREIGN SERVICE OF THE PHILIPPINES )
Consulate General of the Philippines ) S.S.
Jeddah, Kingdom of Saudi Arabia )

SUBSCRIBED AND SWORN TO before me this ______ day of ________________________ 20____

at the Philippine Consulate General, Jeddah, Kingdom of Saudi Arabia.

Doc. no. : __________

Service no. : __________
Series of : __________
O.R. no. : __________ __________________________
Date : __________ Administering Officer