REPUBLIC OF THE PHILIPPINES )

PROVINCE OF EASTERN SAMAR ) S.S.

MUNICIPALITY OF LLORENTE )

AFFIDAVIT OF COHABITATION

We, NAME and NAME, both of legal age, both single and residents of
ADDRESS, Llorente, Eastern Samar, after being sworn to in accordance with law,
depose and say THAT:

1. We have been living together as common law husband and wife at ADDRESS
since YEAR;
2. We are both of single status without any legal impediment to marry each
other;
3. We are executing this affidavit to attest to the foregoing facts and for the
purpose of contracting marriage without the need of securing a marriage
license.

IN WITNESS WHEREOF, we have hereunto set out our hands this DATE 2023
in Llorente, Eastern Samar, Philippines.

NAME NAME
Affiant Affiant
ID NO. ID NO.

SUBSCRIBED AND SWORN to before me DATE 2023 in Llorente, Eastern

Samar, Philippines affiants exhibiting to me the above-stated IDs as competent proof of
their identification.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2023.