REPUBLIC OF THE PHILIPPINES )

CITY OF MAKATI ) S.S.

JOINT AFFIDAVIT ON
DOMESTIC PARTNERSHIP

WE, ____________________ , of legal age, Filipino, single, with address at

____________________________, and
____________________, of legal age, Filipino, single, with address at
____________________________,
after being duly sworn in accordance with law, hereby depose and state that

1. We are single and have no prior existing marriage.

2. I, ____________________ [1st Partner, policyowner] am an applicant for an insurance

policy with Manulife China Bank Life Assurance Corporation. (“Manulife Philippines”)

3. I, __________________ [1st Partner] would like to insure the life of

__________________’s [2nd Partner].

4. We have been living together as husband and wife since __________________ [State Date
of Relationship] or for than five (5) years.

5. We were blessed with a child/children named

__________________/__________________ who was/were born on
________________/__________________. (if applicable)

6. [State the Circumstances of Support/Financial Interest from the 2nd Person]

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_________________________________________________________________.

7. We are executing this Affidavit to attest to the truth of the foregoing and to request
Manulife to recognize __________________’s [1st Partner] insurable interest/financial interest
over the life of __________________ [2nd Partner].

CONFIDENTIAL
 8. In the event that the foregoing are found to be false, and untrue, we understand that the
policy with Manulife will be considered void and without any force and effect in which case the
policy will be rescinded by Manulife. We hereby give our consent to such action for recission by
Manulife. This will be without prejudice to Manulife’s right to proceed against us for such falsity.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS HEREOF, we have hereunto set our hands this _____ day of _______________
at _______________.

___________________________ ____________________________
Affiant Affiant

SUBSCRIBED AND SWORN to before me this _____ day of _______________ affiants

exhibited to me the following competent evidence of their identity with details as follows:

Name Government issued ID Validity Date/Place of Issue

Doc No. _____;

Page No. _____;
Book No. _____;
Series of 2018.

CONFIDENTIAL