Republic of the Philippines )

Province of Agusan dle Sur )s.s

x-------------------------------x

AFFIDAVIT OF COMMON LAW WIFE

I, ELEONOR L. DINLAYAN, _____years old, Filipino, and a resident
of _________, Philippines, after having been duly sworn to in accordance
with law, do hereby depose and state THAT:

1. I am the biological mother of minor ____Dodong____ who was

born on _______

2. That the above mentioned minor is under my care and custody;

3. In his behalf I am competent to certify and sign pertinent

documents, as well as enter into contract/agreement for his best
interest, and for whatever legal purpose;

4. I am not imbecile, insane, a vagrant or a vicious person or a

habitual drunkard or a habitual criminal, and have not abandoned,
neglected or refused to support said minor or caused them to
commit offenses against the law; and

5. I am executing this affidavit to attest to the truth of the foregoing

statement and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I hereunto set my hand this

_________at________, Philippines.

ELEONOR L. DINLAYAN
Affiant

SUBSCRIBED AND SWORN to before me this_________, at

__________, Philippines, affiant exhibiting to me her competent evidence of
identity written below her name and signature.