REPUBLIC OF THE PHILIPPINES                 )
________________________________            ) S.S.
x--------------------------------------------------------x
                     AFFIDAVIT OF SINGLE STATUS
       I, __________________________________, of legal age, single, Filipino citizen,
and presently residing at __________________________________________________,
after having been duly sworn to in accordance with law, do hereby depose and
say:
   1. THAT I have never contracted any marriage in the Philippines or
      elsewhere and I remain SINGLE to this very day and hour;
   2. THAT there is no legal impediment for me to contract marriage under the
      Philippine Laws;
   3. THAT I am executing this Affidavit for the purpose of complying with the
      requirements relating to my application requirements for the
      _________________________________________;
   4. THAT I declare that the statements made in this affidavit are true and
      correct and I am willing to bear all the legal responsibilities arising
      therefrom.
      IN WITNESS WHEREOF, I have hereunto set my hand this ______ day of
_____________________________ at ____________________________________.
                         _____________________________________
                                        Affiant
      SUBSCRIBED AND SWORN TO before me this ____ day of ______________
_____ at ____________________________________________. Upon exhibiting his/her
_______________________________ with _______________ no. ______________________
_____________________ issued on ________________________ in ___________________
__________________________.
Doc. No.: ______
Page No.: ______
Book No.: ______
Series of _______