Aff of de Fact Separation 2

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Republic of the Philippines)

Davao City)S.S.

AFFIDAVIT OF DECLARATION OF DE FACTO SEPARATION

I, _________________, of legal age, Filipino citizen, and a resident of


_____________________, Philippines, after having been duly sworn to, in accordance with
law, do hereby depose and state the following:

1. I got married to _____________________ on ________________ at Tagum City,


Philippines;

2. In November 2018 we mutually decided to separate as husband and wife;

3. Ever since November 2018, I no longer consider myself as married to


________________________; and

4. I am executing this affidavit to attest to the truthfulness of all the foregoing and
for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of


____________________ 2021 at ________________________________________.

_____________________
Affiant
_______________________________

SUBSCRIBED AND SWORN TO before me this _____ day of


__________________________ in _______________________. Affiant exhibited to me his
___________________________________ as competent proof of his identity.
NOTARY PUBLIC

Doc. No. ___________;


Page No. __________;
Book No. __________;
Series of __________.

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