Affidavit Format

REPUBLIC OF THE PHILIPPINES)

C I T Y O F ______________________)s.c.

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

AFFIDAVIT

I, (Insert Name of Affiant) , Filipino, of legal age, single/married to (Insert Name of Spouse if any), and a resident of (Insert Address of Affiant), after having been duly sworn in accordance with law, do hereby depose and say:

1. That .................................................................................................................

...........................................................................................................................

...........................................................................................................................

2. That .................................................................................................................

............................................................................................................................

............................................................................................................................

3. That..................................................................................................................

............................................................................................................................

............................................................................................................................

4. That I am executing this Affidavit to attest to the truthfulness of the foregoing

statements and to (request for the/establish the fact that) ....................................

(copy your request/allegation in the preceding paragraph) and for whatever legal

purpose this may serve best.

Further Affiant sayeth none.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ......... day of ..................... , 20__ in ..................................... Philippines.

........................................................................

(Signature of Affiant over Printed Name)

SUBSCRIBED AND SWORN before me this........ day of ........................... 20__, by ............................................. who exhibited to me his CTC No. ................................... issued on ................................. at ...........................................

Notary Public

Doc. No. .........:

Page No. .........;

Book No. .........;

Series of 20__.