REPUBLIC OF THE PHILIPPINES )

PROVINCE OF CAVITE ) S.S.

CITY OF IMUS )

AFFIDAVIT OF COHABITATION
We, JOSHUA M. LACAP and ROMELYN A. DE LARA, both of legal
age, both Filipino citizens, and both with residence and postal address at Blk. 4,
Lot 18, Greenmark Homes Ext., Malagasang II-C, Imus City, Cavite, after being
duly sworn to according to law hereby freely states, THAT:

1. We have been living together as husband and wife for more than
two (2) years, since year 2020 up to the present without the benefit of marriage;

2. That we have plans for marriage but our priority at the moment is
to save enough money for financial stability prior marriage;

3. That we mutually decided to designated each other as beneficiary of

our medical insurance and HMO application;

4. We execute this Affidavit of Cohabitation freely and voluntarily to

attest to the truthfulness of the foregoing statement and for the application of
medical insurance and HMO and legal purpose it may duly serve.

IN WITNESS WHEREOF, We have hereunto affixed my signature this 20 th

day of February 2023 at Imus City, Cavite.

JOSHUA M. LACAP ROMELYN A. DE LARA

Affiant Affiant
Philpost Identification Card Unified Multi-Purpose ID
No: PRN D61230103672 P CRN-0111-5794453-9

SUBSCRIBED AND SWORN to before me this 20th day of February 2023

at Imus City, Cavite, affiants having exhibited to me their identifications as
affixed below their names above.

Doc. No. 414;;

Page No. 083;
Book No. 285; NOTARY PUBLIC
Series of 2023.