AFFIDAVIT OF CITIZENSHIP FOR BATAS PAMBANSA BLG.

185

I, ________, citizen of _________, of legal age with residence and postal address at
_______________________________________________, after having been sworn in
accordance with law, hereby depose and state that:

1. I was a natural-born Filipino Citizen, born in __________________________ on

________________ to Filipino parents, namely: _________________________ and
_________________________ who are deceased/alive and now residing at
_________________________________________;

2. I am single/ married to _____________________________________________, of legal

age with residence and postal address at
_______________________________________________,

3. I have _______________ of children namely:

___________________________________________________________________;

4. I have lost my Filipino Citizenship through naturalization on ____________ and since

then I have been a citizen of _________________________________;

5. I am acquiring through purchase a parcel of land located in ________________ with an

area of _____ square meters. I hereby affirm that this purchase combined with all of my
other land holdings in the Philippines do not exceed 1,000 square meters aggregate;

6. I intend to use the aforementioned land to permanently reside in the Philippines; and

7. I am executing this sworn statement in compliance with Batas Pambansa Bilang. 185 and
its Implementing Rules and Regulations.

IN WITNESS WHEREOF, I have hereunto set our hand this _________ day of
______________ at _______________________.

________________________
Affiant
(PRINTED NAME OVER SIGNATURE)

NOTARY PUBLIC