REPUBLIC OF THE PHILIPPINES )

CITY OF _________________ ) S.S.

AFFIDAVIT OF INSERTION
I,_______________________________, Filipino citizen, single, of legal age and a
resident of ___________________________________, Ermita, Manila, after being duly
sworn to in accordance with law, depose and state that:

1. That I am the BUYER in the Deed of Absolute Sale executed between me and
_______________________________ involving the Original Certificate Title No.
______________________, of the Registry of Deeds of Tanza, Cavite as notarized
by _________________________________________________________;
2. Unfortunately, my civil status as “single” was not declared in the above said
document;
3. Through this affidavit, I hereby declare under oath that my civil status is
“single” and request such to be inserted or declared in the above said document;
and
4. I am executing this affidavit to attest to the truth and veracity of the foregoing
and for whatever legal purpose the same may serve.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day

of March 2023 in Cavite City.

_________________________
Affiant

SUBSCRIBED AND SWORN to before me this ___ of March 2023 in City of

_________, _______________________, exhibiting to me his ID _____________________
issued on ________________ at __________________.

NOTARY PUBLIC

Doc. No. ___;

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