Republic of the Philippines)

Province of Quirino) S.S.

Municipality of Diffun
x---------------x

AFFIDAVIT OF COHABITATION
(Pursuant to Article 34,
Family Code of the
Philippines)

We, MAR ANSULAO ORTIZ and CHRISTINE GRACE LIZARTE NAVAL, both of
legal age, Filipino, single (living together) and residents of Gayong, Cordon,
Isabela, after having been duly sworn to in accordance with law, do hereby
jointly state, that-

1. We are the above-named affiants as well as the personal

circumstances to whom they pertain;

2. We have been living together as husband and wife under the same
roof, continuously and without any interruption, since January 2000
(more than five years);

3. During our cohabitation and even until the present, there exists no legal
impediment or obstacle between us to marry each other;

4. We were blessed with one son named ___________ who was born on ____;

5. We are willingly and voluntarily executing this instrument to attest to

the truth of the foregoing narrations and for whatever legal purposes
this may serve best.

AFFIANTS FURTHER SAYETH NAUGHT.

MAR ANSULAO ORTIZ CHRISTINE GRACE LIZARTE NAVAL

AFFIANT AFFIANT

SUBSCRIBED AND SWORN before me, this 4 th day of January 2019 in Diffun,
Quirino, Philippines, affiants exhibiting their Community Tax Certificate which
is further described as follows:

NAME CTC NO. ISSUED/AT

MAR ANSULAO ORTIZ 08014105 Diffun, Quirino

CHRISTINE GRACE LIZARTE NAVAL 08014104 Diffun, Quirino

Doc. No. ______

Page No. _____
Book No. _____
Series of 2018.