PHILIPPINE CONSULATE GENERAL )

TOKYO, JAPAN
) S.S.

AFFIDAVIT OF CITIZENSHIP

, a married Filipino, with address at

, after having been duly sworn in accordance with law, do hereby

certify, depose and say that:

1. I am a Filipino citizen from birth until the present;

2. I am in possession of a Philippine Passport No.
issued on
by the Department of Foreign Affairs Manila and valid until
;
3. My husband,
until the present;

(name of husband)

, is a

citizen from birth,

4. On (date of birth of your child), our child (name of child) was born in (place of birth);
5. At the time of his birth, (name of child)
acquired dual citizenship, Philippine
and Japanese citizenship, having been born of a Filipino mother and a Japanese father;
6. (Name of child) is also a Filipino citizen pursuant to the provisions of the 1987
Philippine Constitution;
7. At the time of birth of (name of child), his mother is a Filipino citizen and his father is
a Japanese citizen; and
8. I am executing this affidavit to attest the citizenship of
(name
of
child)
for purposes of filing a Petition for Recognition of his Filipino Citizenship before
the Bureau of Immigration-Manila and for any legal purpose this may serve.

Under penalty of perjury, I declare that the above statement is true and correct to the best
of my knowledge and belief. I am executing this affidavit fully aware that I will be subject to
corresponding criminal, civil and administrative liabilities, including being blacklisted as an
inadmissible foreign national, for any fraud or misrepresentation on my and my childs Filipino
citizenship.

IN WITNESS WHEREOF, I have affixed my signature this

in the City of Tokyo, Japan.

day of

, 2016,

Affiant