Republic of the Philippines )

Province of Cavite ) S.S.

Municipality of Imus )

AFFIDAVIT OF ABANDONMENT AND SEPARATION

I, OLYMPIA MAGRACIA JOSE, of legal age, married, Filipino, and with

residence & postal address at No. 803 Magnolia St., Bliss, Hulo, Mandaluyong
City, after having been duly sworn to in accordance with law, hereby depose and
say:

That I was married to CEFERINO L. JOSE in January 10, 1977 at

Manila City Hall, Manila;

That our union with my husband gave us a daughter named JO-ANNE M.

JOSE, born on September 5, 1979;

That sometime in year 2004, after heated arguments over family

matters/affairs, my husband left our conjugal dwelling, abandoning me
and our daughter Jo-Anne. Since then, he has not returned and failed
to inform us of his whereabouts. He, likewise, failed to provide support
and has not communicated with us since then;

That during the period of more than six (6) years now, my husband has
totally abandoned us and for all legal intents and purposes, we have been
in actual and physical separation continuously for the said period up to the
present;

That I am executing this affidavit to attest to the truth of the foregoing for
all legal intents and purposes.

IN WITNESS WHEREOF, I have hereunto set my hand this 11th of

January 2010 at Imus, Cavite, Philippines.

OLYMPIA MAGRACIA JOSE

Affiant

SUBSCRIBED and SWORN to before me on the date and place above

written, affiant exhibiting to me her SSS ID No 03-2592508-0.

Doc. No.__15__; Atty. CRISANTO U. PASCUAL JR.

Page No.__3; Notary Public
Book No.__I___; Commission Expires on December 31, 2010
Series of 2010. PTR No. 10331456 1-06-10 Imus, Cavite
Roll No. 37506 TIN #117-568-655
Mobile Phone No.(0917)-323-4516