AFFIDAVIT OF APPEARANCE

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I, _________________________________________, a citizen of ______________________,
of legal age, single/married, after having been duly sworn to in accordance with law, do hereby depose
and state that:

1. I am presently residing at ____________________________________________________

___________________________________ and have been in the United States since
___________________________;

2. In compliance with the requirement of the:

________________________________________________________________________
(Name of Office/Agency in the Philippines)

3. I have executed this Affidavit to attest to the fact that I indeed live at the above address; and

4. I have attached herewith a photocopy (each) of my identification document(s) for further

reference.

IN WITNESS WHEREOF, I have hereunto set my signature this _______ day of

_______________________ 20____ at _____________________________________________.

__________________________________
(SIGNATURE OVER PRINTED NAME OF AFFIANT)

Witness:

__________________________________ __________________________________