AFFIDAVIT OF RENUNCIATION OF PHILIPPINE CITIZENSHIP KNOW ALL MEN BY THESE PRESENTS: That I,________________________________________________, of legal age, (Name of Affiant) single/married/widower/separated/ and resident of _____________________________ (address in the UK) ______________________________________________________________________ after being sworn to in accordance with law hereby depose and say:

That I am a Filipino citizen by birth/naturalization/election/Marriage/R.A. 9225; That I am hereby renouncing my Philippine Citizenship for the following reason/s:

(State Reasons Below)

Affiant further sayeth naught. IN WITNESS WHEREOF, I/We have hereunto signed this Affidavit this ________ day of _________________ at London, United Kingdom. ___________________________________ Affiant’s signature over printed name WITNESSES: _____________________________ ____________________________________ Signature over Printed Name Signature over Printed Name EMBASSY OF THE PHILIPPINES) CONSULAR SECTION ) SS LONDON, UNITED KINGDOM ) SUBSCRIBED AND SWORN to before me this ______ day of ________________, in the City of London, United Kingdom, Affiant exhibiting his/her Passport No.____________________________, Issued in ________________ on_______________ Doc. No.: ________ Serv. No.:________ O.R. No.:________ Fee Paid:_________ Form (201 6 ) London PE this form is not for sale and may be reproduced

REQUIREMENTS FOR RENUNCIATION OF PHILIPPINE CITIZENSHIP

1. PRESENT LATEST PHILIPPINE PASSPORT AND SUBMIT A PHOTOCOPY OF THE DATAPAGE. THE PHILIPPINE EMBASSY WILL CANCEL THE EXISTING PASSPORT IF STILL VALID

2. ACCOMPLISH AND SUBMIT THE AFFIDAVIT OF RENUNCIATION OF PHILIPPINE CITIZENSHIP FORM OF THE PHILIPPINE EMBASSY

3. PAY THE NOTARIZATION FEE OF £ 23.00 FOR THE AFFIDAVIT OF RENUNCIATION OF PHILIPPINE CITIZENSHIP

NOTE: THE PHILIPPINE EMBASSY WILL REPORT THE RENUNCIATION OF PHILIPPINE CITIZENSHIP TO THE DEPARTMENT OF FOREIGN AFFAIRS, MANILA, UPON COMPLETION OF ALL DOCUMENTARY REQUIREMENTS.