REPUBLIC OF THE PHILIPPINES)

CITY OF CAGAYAN DE ORO ) S. S.

JOINT AFFIDAVIT OF COHABITATION

We, X and Y, Filipinos, 69 and 70 years old, respectively, both single and
residents of Consolacion, Cagayan de Oro City, after having been duly sworn to
an oath in accordance with law, hereby depose and say, that:

1. We hereby declare that we have been living together for more than ten
(10) years already;

2. Our union has been blessed with two (3) children, namely:

a) A, born on February 7, 1978;

b) B, born on March 7, 1982; and
c) C, born on August 18, 1984;

3. There is no legal impediment preventing us from marrying each other

during the time of our cohabitation;

4. We are therefore free to contract marriage; and

5. We are executing this Affidavit, voluntarily, to attest to the truth of the

foregoing statement, and before affixing our signatures below, its
contents were read and explained to us in the vernacular which we fully
understood.

IN WITNESS WHEREOF, we have hereunto set our hands and affixed

our signatures this 28th day of December 2016 in Cagayan de Oro City,
Philippines.

X Y
Affiant Affiant

SUBSCRIBED AND SWORN to before me on the date and place above-

written by the Affiants who exhibited to me their competent proofs of their
identification.