REPUBLIC OF THE PHILIPPINES}

DUMAGUETE CITY } S.S.

SWORN AFFIDAVIT

I, CLARISSA O. CAÑETE, Filipino, of legal age, and a resident of 4753

Buñao, Dumaguete City, Negros Oriental, after having been sworn to in
accordance with law, depose and say that:

1. I previously contracted marriage with Themestocles P. Cañete on June 18,

1986;

2. Sometime in 1993, due to his incorrigible philandering, abuse, and our

irreconcilable differences, we have mutually agreed to separate de facto;

3. We have previously entered into a written agreement where it was stated

therein that we will refrain from interfering and meddling with each other’s
lives. However, the said written agreement has been lost and deemed
beyond recovery;

4. We have been separated de facto for Twenty Eight (28) years now;

5. I am therefore 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 hand this 23 rd day of August

2021 in the City of Dumaguete.

CLARISSA O. CAÑETE
Affiant

SUBSCRIBED and sworn to before me this 23 rd day of August 2021, in the

City of Dumaguete, by CLARISSA O. CAÑETE exhibiting to me her UMID I.D.
No. CRN-006-0174-7355-4 as competent proof of her identity. Known to me to be
the same person who executed the foregoing document and acknowledged to me
that the same is her free voluntary act and deed.

Doc. No. _____;

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