Republic of the Philippines )

CALACA CITY, BATANGAS) S.S.

AFFIDAVIT OF SEPARATION

I, DONALYN ANDAL ABITAN, of legal age, Filipino, married but separated de facto, and currently
residing in Puting Bato Calaca City, Batangas , do solemnly depose and state the following under
oath:
1. I have been separated from my Husband, Virgilio V. Abitan, since __________________
2. While there has been no formal judicial process of annulment or legal separation, my
estranged Husband, Virgilio V. Abitan , has not been living with me for more than years
now. Furthermore, during this period, he has not been dependent upon me for financial
support.
3. "I hereby declare my children , , ,
as the sole beneficiary of all benefits from my , including but not limited to
, access to regular private rooms, and any other related benefits thereto." Again, it is essential to
consult with a legal professional to ensure the accuracy and effectiveness of your declaration
according to relevant laws and regulations.

4. I am providing this affidavit to affirm the truth of the aforementioned facts, in order to
inform you that my estranged Husband, Virgilio V. Abitan, is not my dependent and should
not be considered a beneficiary. This affidavit is intended to serve any legal intent and
purpose as necessary.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of___________________ in
___________________________.

DONALYN ANDAL ABITAN

Affiant
Passport No: P1587360C

SUBSCRIBED AND SWORN TO before me this _____ day of__________________________ in _______________.

Affiant exhibited to me his/her Community Tax Certificate No. ________________________ issued on
_______________________ at _______________________.

Doc. No.
Page No.
Book No.
Series of 2023