AGREEMENT

KNOW ALL MEN BY THESE PRESENTS:

This AGREEMENT made and entered into at ________________,

________________ Philippines, this _____ day of _______________, 2011, by
and between:

______________________, Filipino, of legal age, with

residence and postal address at __________________,
__________________, hereinafter referred to as “PARTY A”.

-AND-

______________________, Filipino, of legal age, with

residence and postal address at ___________________,
___________________, hereinafter referred to as “PARTY B”.

WITNESSETH; THAT

WHEREAS, PARTY A and PARTY B have been separated in fact for

__________ years;

WHEREAS, PARTY A and PARTY B are no longer communicating with

each other, nor do both parties have any intention of establishing or
doing so in the near future;

WHEREAS, PARTY A and PARTY B have separated all of their property,

both personal and real since _____________________;

NOW THEREFORE, for and in consideration of the foregoing premises as

well as the covenants and agreements hereunder set forth, PARTY A and
PARTY B do hereby agree to the following:

TERMS AND CONDITIONS

1.

2. This AGREEMENT shall be valid and binding as between the parties,

their successors-in-interest and assigns.

IN WITNESS WHEREOF, the parties hereunto set their hands this _____
day of ________________, 2009 at _________________, ____________________,
Philippines.

________________________ __________________________
PARTY A PARTY B

Signed in the presence of:

1
_____________________________ ______________________________