Republic of the Philippines )

CITY OF CAGAYAN DE ORO) S.S.

AFFIDAVIT

I, CARLO BAHIAN ANDAM, of legal age, married, Filipino

and a resident of Barangay Tablon, Cagayan de Oro City, after
having been sworn to an oath in accordance with law hereby
depose and say:

1. That I am married to Judith L. Hermax.

2. That we have no common children.
3. That we have separated in fact for fifteen (15) years.
4. That we did not enter into a marriage settlement before
the wedding.
5. That we did not acquire properties, real or personal
during the marriage.
6. That I execute this affidavit as to the truth of the
foregoing facts and for whatever legal purpose/s this may
serve.

IN WITNESS WHEREOF, I have hereunto affixed my

signature this 13th day of August, 2019 in the City of Cagayan de
Oro, Philippines.

CARLO BAHIAN ANDA

Affiant
Driver’s License No. K02-19-004557

SUBSCRIBED AND SWORN TO before me this 13th day of

August, 2019 in the City of Cagayan de Oro, Philippines.

Doc. No.
Page No.
Book No.
Series of 2019.