AFFIDAVIT OF CITIZENSHIP FOR BATAS PAMBANSA BLG. 185

I, _______________________________, Citizen of __________, of legal age, with residence and postal address at _______________________________________________, after having been sworn in accordance with law, hereby depose and state that:

1. I was a natural-born Filipino Citizen, born in __________________________ on ________________ to Filipino parents, namely: _________________________ and _________________________ who are deceased/alive and now residing at _________________________________________;

2. I am single/ married to _____________________________________________, of legal age with residence and postal address at _______________________________________________;

3. I have _______________ of children namely: ___________________________________________________________________;

4. I have lost my Filipino Citizenship through naturalization on ____________ and since then I have been a citizen of _________________________________;

5. I am acquiring through purchase a parcel of land located in ________________ with an area of _____ square meters. I herebyaffirm that this purchase combined with all of my other land holdings in the Philippines do not exceed 1,000 square meters aggregate;

6. I intend to use the aforementioned land to permanently reside in the Philippines; and

7. I am executing this sworn statement in compliance with Batas Pambansa Bilang. 185 and its Implementing Rules and Regulations.

IN WITNESS WHEREOF, I have hereunto set our hand this _________ day of ______________ at _______________________.

___________________________

Affiant

NOTARY PUBLIC