REPUBLIC OF THE PHILIPPINES )CITY OF CEBU ) S.S.x-------------------------------------x  

AFFIDAVIT

I, __________________, Filipino, of legal age, married, presently residing at ______________________, after having been sworn in according to law, do hereby depose and state that:

1. I purchased a condominium unit in Urban Deca Homes Tipolo, a project of Fog Horn, Inc.;

2. That I applied for in-house financing for the purchase of the said unit, which will be paid in 25 years;

3. That I am currently actually separated with my husband and plan to file for an annulment of our marriage before the end of the 25 year financing period;

4. That in my application, I indicated that my civil status is “single” in anticipation of the said annulment;

5. That my married name is _________________.

Further Affiant sayeth naught.

IN WITNESS WHEREOF, I hereby affixed my signature this ___________________ in Cebu City, Philippines.

________________________Affiant

SUBCRIBED AND SWORN TO before me this _____________ in ______________, Philippines, affiant exhibiting to me his/her competent evidence of identity passport no. EC0934032.     Doc. No. _____;Page No. _____;Book No. _____;Series of 2015.