REPUBLIC OF THE PHILIPPINES )
PROVINCE OF ________ )
CITY OR MUNICIPALITY OF ________ ) S.S.

AFFIDAVIT OF SINGLE STATUS

I, ________, Filipino, of legal age, single, and a resident of ________, after having been duly sworn to in accordance with law, do hereby depose and state THAT:

1. I was born on ________ in ________, as evidenced by my Certificate of Live Birth registered with the Philippine Statistics Authority and/or the Local Civil Registrar;

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3. I solemnly affirm and confirm that I am presently single, unwed, and possessed of full legal capacity to contract marriage in accordance with the Family Code of the Philippines (Executive Order No. 209, as amended);

4. I am not afflicted with any legal impediment to marry and there exists no fact or circumstance that would render me incapable of validly contracting marriage under Philippine law;

5. I have the following child/children, namely:

________, Male, born on ________ in ________;

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7. I am executing this Affidavit for the purpose of supporting my application for a Marriage License, in compliance with the requirements of the Family Code of the Philippines and the rules and regulations of the Local Civil Registrar, as well as for ________;

8. I fully understand that any false statement made herein shall render me liable for Perjury under Article 183 of the Revised Penal Code of the Philippines and for such other liabilities as may be provided by law;

9. I am executing this Affidavit to attest to the truth of all the foregoing statements and for whatever legal purpose and intent this instrument may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ________ day of ________, 20________ at ________, Philippines.

________
Affiant

SUBSCRIBED AND SWORN TO before me this ________ day of ________, 20________ at ________, Philippines, affiant ________ having personally appeared before me and exhibited to me competent evidence of identity in the form of Postal ID No. ________, issued at ________ and valid until ________, and known to me, or duly identified by me, to be the same person who executed and voluntarily affixed his/her signature on the foregoing Affidavit, and who acknowledged to me that the same is his/her free and voluntary act and deed.

________
NOTARY PUBLIC
Until: ________
PTR No.: ________; Date/Place Issued: ________
IBP No.: ________; Date/Place Issued: ________
Roll of Attorneys No.: ________
MCLE Compliance No.: ________
Office Address: ________

Doc. No.: ________;
Page No.: ________;
Book No.: ________;
Series of ________.