REPUBLIC OF THE PHILIPPINES )

CITY OF MABALACAT ) –s.s.

AFFIDAVIT

I, xxx, of legal age, Filipino, with residence and postal address at

yyyyyyyyyyyyyyyyyyyyyyyyyyy, after having been duly sworn to in accordance with
law, hereby depose and say, that:

1. I am the Petitioner in the case entitled xxx, Civil Case No. R-ANG-xxx- CV,
for Declaration of Absolute Nullity of Marriage dated 2018, hereto attached
and made an integral part hereof, the dispositive portion of which, reads as
follows:

WHEREFORE, premises considered, the prayers

in the Petition are hereby PARTIALLY GRANTED.
Accordingly, judgment is hereby rendered:

(1) DECLARING the marriage between

petitioner xxx celebrated on 1999 VOID AB
INITIO, it being a bigamous marriage,
pursuant to paragraph 4, Article 35 of the
Family Code of the Philippines;
(2) ADJUDGING all the LEGAL EFFECTS of
termination of the marriage of petitioner
xxx pursuant to Article 50 in relation to
Article 43 of the Family Code of the
Philippines.

Xxx xxx xxx

2. Suffice it to say that the Order of Finality shall be forthcoming.

3. I hereby undertake to submit the aforementioned document within a

reasonable period, or as soon as it becomes available;

4. I bind myself criminally, civilly and administratively liable and will assume full
responsibility for any third party claim, and hereby hold the Philippine
Statistics Authority (PSA) and any of its employees free from any liability
arising from any claim for damages.

5. I am executing this affidavit in order to attest to the truth of the aforesaid facts
and to justify the use of this affidavit for whatever legal purposes it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

________________ at City.
 xxxxxxxxxxxxxxxxxxxxxxx
Affiant

SUBSCRIBED AND SWORN to before me __________________ in

Mabalacat City, Philippines, affiant exhibiting to me her Driver’s License No.
xxxxxxxxxxx, issued on _______________in ______________, personally known to
me, who is the same person who personally signed before me the foregoing
“Affidavit” and acknowledged that he executed the same.

Doc. No. ____;

Page No. ____;
Book No. ;
Series of 201.