REPUBLIC OF THE PHILIPPINES )

CITY OF CEBU_____________) SS.

SWORN AFFIDAVIT

I, NILO BOTAY, of legal age, Filipino and a resident of

__________________, Philippines, after being duly sworn to in accordance with law
do hereby deposed and say:

1. That I am married to NILA ROTAY since____________. Copy

of our marriage certificate herein attached as Annex “A” ;

2. That I was employed in the Armed Forces of the Philippines

since__________________;

3. That I was stationed at_____________________for the period

of _______until___________________.

4. That during the above-mentioned period I have been living

separately from my wife and family for the reason that I was assigned
in______________and my wife was left at our home in_______________to
manage the household ;

5. That I executed this Sworn Affidavit to attest to the foregoing

facts and circumstances and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ___________

at the _________________, Philippines.

NILO BOTAY
Affiant
Type of ID:_______________
ID No.: __________________

SUBSCRIBED AND SWORN to before me, this ___________ at the

______________________, Philippines, affiant exhibiting to me the competent
evidence of identity indicated above.

Doc No. ____:

Page No. ___;
Book No. ___;
Series of 2015.