REPUBLIC OF THE PHILIPPINES )

__________________________ ) S.S.

AFFIDAVIT OF SINGLE STATUS

I, _________________, of legal age, single, and a resident of

_____________________, after having been duly sworn in accordance with law, hereby
depose and state that:

1. That I have never been married nor entered into any marriage contract or wedding
ceremony in the Philippines or abroad;

2. That since birth up to the present, my marital status remains SINGLE;

3. That I am executing this affidavit to attest to the truth of the foregoing and for
whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hands this 19th day of July
2022 at _____________, Bulacan.

________________
Affiant

SUBSCRIBED AND SWORN to before me this this ___________ at

___________________.

III-MALOLOS-2022-JULY-______