REPUBLIC OF THE PHILIPPINES)

AFFIDAVIT OF NO INCOME

I, ___________________, of legal age, married, Filipino, and a

resident of ______________, after having been duly sworn to in accordance
with law, hereby depose and state, that:

1. I am the wife of _____________ who is presently residing in Japan;

2. Out of our cohabitation as husband and wife, we begot one child,

______________;

3. My husband and I were separated in fact since year 2007;

4. I hereby declare under solemn oath that our child and I are not
receiving any form of financial support from _____________ or from
the Government of the Republic of the Philippines;

5. I am presently jobless and have no monthly income;

6. I have executed this affidavit to attest to the truth of all the foregoing
facts and for whatever legal purpose this may serve.

IN TRUTH WHEREOF, I have hereunto affixed my signature this

___________________, in _______________

_________
Affiant
Passport No.
Valid until:

SUBSCRIBED AND SWORN TO before me

this_______________________ in _________, affiant exhibiting to me
hiscompetent evidence of identity.

Doc. No._________
Page No. ________
Book No.________
Series of 2020.