REPUBLIC OF THE PHILIPPINES)

CEBU CITY ) S.S.

AFFIDAVIT OF JUSTIFICATION/EXPLANATION

I, _____________________, Filipino, married to ______________, American, of

legal age, with address at ____________________, after being duly sworn according to
law, hereby depose and state that:

1. I am a natural born Filipino citizen by birth;

2. I lost my Filipino citizenship when I was naturalized as a citizen of the

United States of America on _______;

3. I intend to stay in the Philippines for good. I would also like to retain and
reacquire my Philippine citizenship under Republic Act No. 9225;

4. As a requirement for my petition with the Bureau of Immigration, I have

executed my Oath of Allegiance on _________________, under Doc. No.
______, Page No. _____, Book No. ______, Series of 2019 before notary
public __________.

5. My Oath of Allegiance was not taken before the Bureau of Immigration

Legal Officer in Metro Manila because I have difficulty in traveling to
Manila due to ________________. Furthermore, when I proceeded to the
Bureau of Immigration in Cebu City, there was no legal available, and I was
recommended to take my oath before a lawyer.

6. That I am executing this affidavit to attest to the truth of the foregoing and
for whatever legal purpose this may serve.

AFFIANT FURTHER SAYETH NAUGHT.

Affiant

SUBSCRIBED AND SWORN to before me this _____________, at Cebu City,

affiant, ________________, personally appeared before me and exhibited to me ID
no. ___________ which was issued on ______.

Doc No.: _____;

Page No.: ____;
Book No.: ____;
Series of _____.