REPUBLIC OF THE PHILIPPINES)

CITY OF ) SS.
x-----------------------------------------x

AFFIDAVIT OF BEING SINGLE

I, , 22 years old, single, Filipino, and resident of San Nicolas, City,

Nueva Ecija, under oath hereby depose and state:

1. That I am the fourth child among the brood of five of

spouses and I was born on July 29,1990 at, Nueva Ecija;

2. That I am single, never been married or entered into a

contract of marriage no cohabitated with any man herein
the Philippines or elsewhere;

3. That I am executing this affidavit to attest to the veracity of

the above-stated facts and for whatever legal purposes this
may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature

this 21st day of February,2013 in the, Nueva Ecija.

Affiant
Passport Presented
Passport No. 72526

SUBSCRIBED AND SWORN to before me this 21 st day of February,2013

in the City of, Nueva Ecija.