REPUBLIC OF THE PHILIPPINES )

CITY OF __________ ) S.S.

AFFIDAVIT OF ECONOMIC STATUS

I, __________________ , Filipino citizen, married, of legal age,

and residing at ____________________________, after having been duly
sworn to in accordance with law do hereby deposes and states that;

1. my wife is applying for Green Card at Makati Medical Center,

Makati City, and in connection therewith, I am required to
submit a sworn statement of my economic status, hence this
affidavit;

2. I would like to state under oath that I am unemployed and my

source of income is ___________________________ with an
average income of _________________ per month. I am
dependent on the support of my wife who is a _______________
with a basic salary of ____________________________ per month;

3. I am executing this affidavit to attest to the truth of the

foregoing facts and in order to inform the proper authorities
concerned for all legal intents and purposes this may serve.

AND FURTHER AFFIANT SAYETH NAUGHT.

_______________________
Affiant

SUBSCRIBED AND SWORN to before me this

___________________________ at _________ City, affiant exhibiting to
me his Professional Driver’s License ID No. _________________.

Doc. No. ________

Page No. ________
Book No. ________
Series of 201_