AFFIDAVIT OF SEPARATION

Republic of the Philippines)

) S. S. for

I, _______________________________________ of legal age, Filipino and presently

residing at _________________________________________________________, after being
duly sworn in accordance with law, do hereby depose and state that:

1. I was married to ____________________________ on ______________ at

________________________________, and she/I still using my/his surname in
all of her personal and business transaction.

2. Said marriage was blessed with ____________ children namely

_____________________________________________________________ .

3. However, since ____________ up to present, and for several serious reasons, my

wife/husband and I were living, in truth and in fact, separately and independently
of each other;

4. That I applied for a Car Loan with BANK.

5. That I am applying for an auto loan with the BANK and the source or repayment
is solely from my income;

6. I am executing this affidavit to attest to the truth of the foregoing and in support
of my application for loan with BANK.

IN WITNESS WHEREOF, I have hereunto affixed my signature this _____ day of

____________________ 20___ in _______________________.

______________________
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME, Notary Public for and in the City of
___________________ by affiant, ___________________ exhibiting to me her Community Tax
Certificate No. ______________ issued on ___________________.

NOTARY PUBLIC

Doc. No. __________

Page No. __________
Book No. __________
Series of 20___