REPUBLIC OF THE PHILIPPINES)

___________________________) S.S.

AFFIDAVIT OF ABANDONMENT
AND NO LEGAL SEPARATION

I, MELISSA ORTIZ, of legal age, Filipino and presently residing at

______________________________ after having been duly sworn to in accordance with
law, hereby depose and state that;

1. I am married to Renante Santos on ________________ in ________________ ;

2. We begot a child out on _____________________ who was born on

____________________ at ___________________and was named as
Renante Dulay, Jr.;

3. My said husband abandoned me and our child since 1991 due to our
marital problem;

4. I filed a petition for _____________________ for my said husband and child on

__________________;

5. In said petition for ____________________, I included my husband because he

is still included as part of my family because we are not legally separated or
there was no petition in any court that was filed or obtained by me or my
said husband for divorce, legal separation and annulment of marriage;

6. However, due to inabilility to contact my said husband, I have decided to

drop (withdraw) my petition of ________________ for him;

7. I am executing this affidavit to attest to the veracity of the foregoing

facts and for whatever purpose this may serve best.

IN WITNESS WHEREOF, I have hereto signed my name this __________ day of

_____________ in ______________________.

MELISSA ORTIZ
Affiant

SUBSCRIBED AND SWORN to before me this ___TH day of August 2016 at

____________________________.

Notary Public

Doc. No. ____;

Page No. ___;
Book No. ___;
Series of 2016.