Republic of the Philippines}

CITY OF ORMOC} S.S.

STATUTORY DECLARATION OF COMMON LAW SPOUSES

We, EL JAY M. CORNEL and SHAREMELA MARIE D. CODIÑERA,

both of legal age, Filipino citizens, both single and presently residing at
713 Cataag St., District 13, Ormoc City, Leyte, Philippines, after having
duly sworn to in accordance with law, hereby depose and say THAT:

1. We are both undergraduates in Bachelor of Science in Pharmacy;

2. We have been living together as common law spouses without

the benefit of marriage since November 2019 or for more than
two (2) years now and are presently residing at 713 Cataag St.,
District 13, Ormoc City, Leyte Philippines;

3. We have no legal impediment to marry and already have plans

to be married sooner;

4. We are executing this Affidavit to affirm and confirm the

foregoing facts and for any legal purpose it may serve.

IN WITNESS WHEREOF, we have hereunto affixed our signatures

this 16th day of February 2022 in Ormoc City, Leyte, Philippines.

EL JAY M. CORNEL SHAREMELA MARIE D. CODIÑERA

Affiant Affiant
Postal Identity Card Postal Identity Card
PRN I24200372802P PRN I24200372827P
Valid until November 26, 2023 Valid until November 26, 2023

SUBSCRIBED AND SWORN to before me this 16th day of February

2022 in Ormoc City, Leyte, Philippines, with the affiants exhibiting to me
competent proof of their true identities, pertinent details of which are
indicated below their respective names.

ALEXANDER G. SALAS, JR.

Notary Public
Ormoc City, Kananga, Matag-ob
Merida and Isabel, Leyte
Until December 31, 2021 (Extended to June 30, 2022)
Commission No. ORM-19-12-023
Real cor. Aviles Sts., Ormoc City
Doc. No. _____; Attorney’s Roll No. 65086
PTR No. 7053400
Page No. _____; Ormoc City, January 3, 2022
Book No. IX; IBP O.R. No. 183020, 1/3/2022
MCLE Compliance No. VI-0011172
Series of 2022. Valid until April 14, 2022
TIN 263-562-019