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;

2. I have never been married to, nor have I contracted any marriage with, any person, whether under the laws of the Philippines or of any other jurisdiction, and I have never entered into any contract of permanent union with any person;

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 ________;

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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 ________.