years old, single and a resident of 3rd Street Brgy. 83 San Jose Paraiso Tacloban City, Philippines, after having been duly sworn in accordance with law, hereby depose and state:
1. That I have never entered into any form of special
contract of permanent union with any woman for the establishment of conjugal and family life;
2. That I therefore confirm and affirm that my civil status
as of this date is single and unmarried;
3. That as such, I have no knowledge of the existence of
any record in any Civil Registry of the Philippines which states the fact of my marriage;
4. That I am executing this affidavit to declare the truth of
the foregoing facts and for the purpose of applying for a Marriage License pursuant to the provisions of the Family Code of the Philippines.
IN WITNESS WHEREOF, I have hereunto set my hand
this 26th day of May 2021 at Tacloban City, Philippines.
CLARK STEVEN HONOR CANEJA
Affiant
SUBSCRIBED AND SWORN to before me, this 26th
day of May 2021 in Tacloban City, Philippines, by affiant who exhibited to me his LTO Driver’s License with No. G14-14-000038 valid until 04/14/2026 and bearing his photograph and signature, known to me to be the same person who executed the foregoing affidavit.