REPUBLIC OF THE PHILIPPINES )

PROVINCE OF AKLAN ) S.S

MUNICIPALITY OF KALIBO )
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AFFIDAVIT OF COHABITATION

We, _________________ and ________________, all of legal ages, and a residents of

___________________, after having been duly sworn to in accordance with law, hereby
depose and state the following:

That we had been living together as husband and wife for the last ____ years;

That we do not possess any legal impediments to contract marriage;

That this affidavit is executed with our intention to get married in accordance
with the rites of civil marriage and for legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this_______________ at Kalibo, Aklan, Philippines.

SUBSCRIBED AND SWORN to before me on this ______________ in Kalibo,

Aklan, Philippines.

ROWENA MAE N. MENCIAS

Notary Public
Refindor Bldg., Capitol Site, Estancia, Kalibo
Aklan; Roll No. 62828; PTR No. 5446695, Kalibo,
Aklan, January 10, 2017; IBP No. 949238, Kalibo,
Doc. No. Aklan, January 10, 2017; MCLE Compliance
Page No. No. V-0015889; Notarial Commission No. 15
Book No. (2016-2017)
Series of 2017.