REPUBLIC OF THE PHILIPPINES)

) S.S.

AFFIDAVIT OF COHABITATION

I, ________________, of legal age, married, and Barangay Captain of __________ , after

having been duly sworn to according to law, hereby depose and state:

1. That I am the Barangay Captain of Barangay ___________________;

2. That as said Barangay Captain I know ______________ and ______ who were both
residents of my Barangay specifically residing at _______, of this barangay;

3. That as Barangay Captain, I personally knew them to be living together and

cohabiting without the benefit of marriage since five (5) years from date of this
affidavit and out of their cohabitation a son/daughter, named __________ was born
on _____;

4. That I am executing this affidavit in order to attest to the truth of the above
circumstances and for the purpose of compliance with the requirements of
________.

IN WITNESS WHEREOF, I have hereunto set my hand, together with my two Kagawads
as witnesses on this ______ at ________.

_________
Affiant

WITNESSED BY:

____________________ __________________

SUBSCRIBED AND SWORN to before me this ______ day of __________, 202__ at ____
__________, affiant personally appeared and exhibited to his _____________ issued at
________ on ________, 202__.

Doc. No.__
Page No.__
Book No.__
Series of 202__.