Republic of the Philippines )

City/Municipality ) S.S.

AFFIDAVIT OF SINGLENESS

I, (name), Filipino, of legal age, (civil status), and a resident (place of residence),
after having been duly sworn to in accordance with law hereby depose and state that:

1. I am the daughter of spouses (name of parents), and I was born on (date of birth) in
(place of birth);

2. I have never contracted any marriage in the Philippines or elsewhere and I

remain to be SINGLE to this very day and hour;

3. There are no legal impediments for me to contract marriage under the existing
Philippine Laws;

4. I am executing this affidavit for the purpose of complying the requirements

relating with my forthcoming marriage with (name of future spouse) Filipino, of
legal age, single, and a resident of (place of residence future spouse);

5. I hereby state under pain of perjury and without any intent to mislead the public
that I have never been married before and remain to be SINGLE by civil status;
and

6. I have executed this affidavit to attest to the truth and veracity of the foregoing
statements, free from any duress, force, intimidation, threats, violence, or any
form of vice of consent, for whatever legal purpose the same may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this (date), in the

City of (place), Philippines.

(Name)
Affiant

SUBSCRIBED AND SWORN TO Before me a Notary Public for and in the City of
_____________________, Philippines this _________________. Witness my hand and seal
in the date and place above-stated.

Doc. No.: (Notary’s Signature)

Page No.:
Book No.:
Series of _____