REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAVITE ) S.S.

____________________ )

AFFIDAVIT OF JUSTIFICATION/EXPLANATION
I, JUAN DELA CRUZ, of legal age, Filipino citizen, married and a resident of
_______________________, Cavite, after having been sworn in accordance with law,
hereby depose and state that:

1. I am a natural born Filipino citizen by birth as evidence by my Certificate

of Live Birth;

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

States of America on _______________;

3. I intend to stay in the Philippines for good. Hence, I would also like to
retain and re-acquire 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 January 8, 2021 before notary public
_________________ under Doc No.1, Page No. 1, Book No I, and Series of 2021;

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

Officer in Metro Manila because I am already a senior citizen, sixty six (66) years
old, hence it is already hazardous for me to travel to Metro Manila during this
COVID-19 pandemic;

6. I am executing this affidavit to attest to the truth of the foregoing statements

and for other legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of January
2021, in the City of Trece Martires, Province of Cavite, Philippines.

JUAN DELA CRUZ

Affiant

SUBSCRIBED AND SWORN TO, before me this 8th day of January 2021,
in the City of Trece Martires, Province of Cavite, Philippines, by the affiant who
exhibited to me her Senior citizen identification card with number 1234 issued in
Cavite on February 1, 2017.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2021.