REPUBLIC OF THEPHILIPPINES)CITY OFCEBU )S.S.x-------------------------------------xAFFIDAVIT

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 TObefore me this_____________in ______________,Philippines, affiant exhibiting to mehis/her competent evidence of identity ______________________________. Doc. No. _____;Page No. _____;Book No. _____;Series of 2015.