AFFIDAVIT OF CITIZENSHIP FOR BATAS PAMBANSA BLG.

185

I, _______ at residence ____________________________________________, after having

been sworn in accordance with law, hereby depose and state that:

1. I was a natural-born Filipino Citizen, born in Manila on __________________, to

Filipino parents, namely: __________________ Reyes and __________________who are alive
and now residing at ______________________________________.

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

______________________________________.

3. I have two children namely:

1.

2.

4. I have lost my Filipino Citizenship through naturalization on February 2006 and

since then I have been a citizen of Canada;

5. I am acquiring through purchase a parcel of land located in

___________________________________________with an area of _____ square meters. I
hereby affirm 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 _______________________.

For: __________________
Affiant

Atty. __________________
Attorney-in-Fact

SIGNED IN THE PRESENCE OF:

_____________________________ _____________________________
 ACKNOWLEDGMENT

Republic of the Philippines)

City of Muntinlupa ) SS.

BEFORE ME, a Notary Public for and in the above jurisdiction,

personally appeared this __ day of ________, 2018.
NAME IDENTIFICATION # DATE/PLACE ISSUE
Atty. __________________

Known to me to be the same persons who executed the foregoing

instrument and each of the acknowledge to me that the same is his/her own
free and voluntary act and deed.

WITNESS MY HAND AND NOTARIAL SEAL, on the date and at the

place first above written.

Doc. No.; NOTARY PUBLIC

Page No.;
Book No.;
SERIES of 2019.