REPUBLIC OF THE PHILIPPINES )

CITY OF XXXXXXX ) S.S.

AFFIDAVIT OF COHABITATION

I, XXXXXXX, of legal age, Filipino, widow, and with address at XXXXXX, after being duly
sworn in accordance with the law, hereby depose and state that:

1. That I and my late husband, XXXXXXXX, have been living together as husband and
wife under the same roof, continuously and without interruption, since XXXXXXX until
his demise;

2. That during our cohabitation and even until the present, there exists no legal impediment
or obstacle between us to marry each other;

3. That during our cohabitation, we were blessed with four children namely:;

4. That on November XXXXX, in XXXXXX City my husband XXXXXXXX died;

5. I am executing this affidavit to attest to the truthfulness of the foregoing.

IN WITNESS WHEREOF, I have hereunto affixed my signature and seal this 15th day of
XXXXXX 2022 at XXXXXXXX CITY.

XXXXXXX
Affiant

SUBSCRIBED AND SWORN to before me this 15TH day of November 2022 at Zamboanga
City affiant is personally known to the Notary Public.

Doc. No.
Page No.
Book No.
Series of 2022