REPUBLIC OF THE PHILIIPINES )

MUNTINLUPA CITY ) S.S.

AFFIDAVIT OF ABANDONMENT

I , ___________________ of legal age, Filipino and a resident of

_________________________, after being duly sworn to in accordance with law depose
and say:

That I am the legal wife of _______________________;

That we took our nuptial vows on _____________________ in __________;

That out of such lawful marriage, we begot one (1) child, named ____________,
______ years old;

That, nevertheless, sometime in ___________, my said ____________

abandoned us;

That since the day my husband left us, he has never returned nor revisited us,
hence, I have been the one supporting my children financially and morally;

That to this date, my husband ___________________ and I have not been

communicating and I have not heard of him since then;

That I am executing this affidavit to attest to the truth of the foregoing facts and
for whatever legal purposes it may serve;

IN WITNESS HEREOF, I am affixing my signature this

__________________________ in Muntinlupa City.

_____________________________
Affiant

SUBSCRIBED AND SWORN to before me in the date and place

abovementioned.