REPUBLIC OF THE PHILIPPINES )

City of Kabankalan ) S.S.

x --------------------------------------------- x

AFFIDAVIT

I, _______________, of legal age, single, Filipino, a resident of _________,

Philippines, after having been sworn to in accordance with law, depose and say that:

1. I begot a child with __________________ in the name of _________________, born on

___________. ___________________ and I were never married but we were able to
recognize _________________ as our child in the latter’s Certificate of Live with
Registry _______________ registered at the Local Civil Registrar of ____________;

2. _______________ and I have long separated ways and he now lives in Manila;

3. My son ________________, now of legal age, intends to marry __________________

and the ceremony is intended to take place on _________________ at _________;

4. As to the intended marriage, I have given my consent and advice to my son and his wife-
to-be and for all intents and purposes, I support the bride and groom-to-be in their
intent to marry;

5. Considering that I have since then exercised primary care and custody over my son, I
will attend his wedding ceremony as A SOLE PARENT because
___________________ has long been absent in his life. I understand and will solely
assume the obligations pertaining to the parent(s) of the groom-to-be
____________________ before, during, and after the marriage;

6. I have executed this affidavit out of my free will to attest to the truth of the foregoing
facts to desist from further prosecuting the above-mentioned criminal case and for
whatever legal purpose this affidavit may serve; and

7. This affidavit was explained and translated to me in Ilonggo, a language that I fully
know and understand by the undersigned administering officer.

IN WITNESS WHEREOF, I have hereunto set my hand this _________ at

_______________, Philippines.

_____________________________
Affiant/ID No. __________

SUBSCRIBED AND SWORN to before me this _______________ at __________,

Philippines. I HEREBY CERTIFY that I have personally examined the herein affiant and I
am satisfied that she voluntarily executed and understood her given affidavit

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