A F F I D A V I T OF NO BLOOD RELATION I, _______________________________________, Filipino, of

legal age, presently residing in _______________________________, after having been duly sworn to in
accordance with law do hereby depose and state: That I am not in any way, by blood or affinity,
related to Ms. ________________________, holder of Philippine Passport No. ____________________,
issued on ____________________ in _________________________; and That this affidavit was
executed for the purpose of acquiring the services of Ms. ______________________, as my housemaid,
in United Arab Emirates; Affiant further sayeth naught. IN WITNESS HEREOF, I hereunto set my hands
and affix my signature this ________________ at the Consulate General of the Republic of the
Philippines, Dubai, United Arab Emirates. ________________________________ Name and Signature of
Affiant SUBSCRIBED AND SWORN to before me this ______________________at the Philippine
Consulate General, Dubai, United Arab Emirates, the affiant(s) having exhibited his/her valid passport,
copy of which is attached