REPUBLIC OF THE PHILIPPINES)

__________________________________) S.S.

AFFIDAVIT

I, ____________, of legal age, Filipino citizen, widow and a resident of

________, after being sworn in accordance with law, hereby depose and state
that –

1. I am the mother of ______;

2. My daughter was married to ________ at ______;

3. Their marriage was registered in the Philippines as evidenced by a

Certificate of Marriage, a copy of which is attached herein;

4. Finally, I am executing this affidavit to attest the truth and veracity

of the foregoing statements and for all legal intents and purposes it may serve;

5. Affiant sayeth naught.

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_________ at ______ Philippines.

Affiant

SUBSCRIBED AND SWORN to before me, this _________ at ___________

affiant exhibiting to me her valid ID, bearing her photograph and signature as
competent evidence of her identity.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2021.