AFFIDAVIT IN LIEU OF CERTIFICATE OF LEGAL CAPACITY TO

CONTRACT MARRIAGE FOR U.S. CITIZENS

Before me, ________________________(Notary Public) personally appeared the undersigned

who, being duly sworn, states:

1. My name is _____________________________________ , of legal age, and I am a citizen of

the United States of America;

2. I hold U.S. passport# ______________________ , issued on __________________;

issued at U.S. Department of State ;

3. I am a legal resident of (state) ___________________________________________;

4. My address while in the Philippines is _____________________________________

______________________________________________________________________.

5. (Check which applies)

____ I have never been married; OR

____ I have been married ____ (number of times) times previously. All previous
marriages have been legally terminated.

______________________________________

(Affiant’s Signature)

SUBSCRIBED AND SWORN to before me on _________________ at

____________________________.

__________________________________
Notary Public
SEAL