Republic of the Philippines)

Province of Surigao del Sur) S.S

C I T Y O F T A N D A G)
X-------------------------------/

JOINT-AFFIDAVIT OF COHABITATION

WE, ________________________________, of legal age, married, and a resident of

________________________________________, after having been duly sworn to under oath
hereby depose, and competent to testify, solemnly declare and affirm under penalty of perjury that
the following statements are true and accurate to the best of my knowledge and belief, and states:

1. That we are making this affidavit with respect to the relationship between the deceased
partner, [Deceased Partner's Name], and the live-in partner, [Live-in Partner's Name];

2. That we have personal knowledge of the living arrangements and relationship between
[Deceased Partner's Name] and [Live-in Partner's Name;

3. That [Deceased Partner's Name] and [Live-in Partner's Name] began living together as
domestic partners on or around [Date of Commencement], and they continued to live
together until the death of [Deceased Partner's Name] on [Date of Death;

4. That during this period, [Deceased Partner's Name] and [Live-in Partner's Name] resided
at the same address, which was [Address where they lived together];

5. In contrast, [Legal Wife's Name], who is the legal wife of the deceased, did not
contribute to the burial expenses of [Deceased Partner's Name] when he passed away;

6. We declare under penalty of perjury under the laws of [Your State/Country] that the
foregoing is true and correct.

7. That we are executing this Affidavit to attest to the truth and veracity of the foregoing
statement and for whatever legal purpose this may serve best.

IN WITNESS WHEREOF, we hereby affix our hands this___ day of __________, in

_________________, Philippines.

_________________________________ _________________________________
Affiant Affiant
ID No. ____________________ ID No. ____________________

SUBSCRIBE and SWORN to before me this___ day of __________, in

_________________, Philippines. Affiants exhibited to me their Identification card as stated
above.

Doc. No. ____,

Page No.____,
Book No. _____,
Series of 2023.