REPUBLIC OF THE PHILIPPINES )

______________________________ ) S.S.
______________________________ )

AFFIDAVIT OF INTENT TO MARRY

I, xxx, of legal age, single, with address at xxx, Philippines, and a xxx Citizen, under oath,
depose and state:

1. THAT I am a holder of xxx issued on xxx at xxx, Philippines;

2. THAT I was born on xxx at xxx, Philippines;

3. THAT I intend to marry xxx, xxxx, of legal age, single, with address at xxx;

4. THAT I give the following persons as references to support my statement:

a. name – address, Philippines; and
b. name – address, Philippines;

5. THAT I am qualified and eligible to marry xxx under Philippine laws;

6. I am executing this Affidavit to attest to the truth of the foregoing facts and to use
the same for whatever legal purpose it may serve.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I hereunto affix my signature this xxx at xxx.

xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Affiant

SUBSCRIBED AND SWORN to before me this xxx at xxx, Affiant exhibiting to

me his xxx issued at xxx, Philippines on xxxx.

NOTARY PUBLIC

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