AFFIDAVIT OF MARITAL SEPARATION

KNOW ALL MEN BY THESE PRESENTS:

I, _____________________, Filipino, of legal age, married, and a resident of

#_____________________________________________, after having duly sworn to in
accordance with law, hereby depose and state:

1. I am separated and estranged from my spouse, ___________________, and that we have

been living separately since ____________________.

Spouse’s Last known address: _____________________

Spouse’s Birth Date: _________________________

2. We had contracted marriage on ___________________, in the City of Manila and did not
have any children.

3. I have not begun the legal process for annulment of marriage for financial reasons.

4. I do not intend to reconcile with my spouse. I have not received, do not seek nor
anticipate receiving any compensation from my spouse in the future.

5. I do not require approval from my spouse for any financial and legal transactions
contracted by me and in my name.

I hereby certify that the information provided above is accurate and complete to the best of
my knowledge

IN WITNESS WHEREOF, I have hereunto set my hand this _____________________at

Quezon City.

__________________________
Affiant