REPUBLIC OF THE PHILIPPINES )

CITY OF ) S.S.

AFFIDAVIT OF FAMILY RELATIONSHIP

I, ________________________________, of legal age, married, Filipino, a

resident of __________________________, after having been subscribed to an
oath, depose and say:

1. That I am the first cousin of __________________________ who is now

working at Dubai, United Arab Emirates and with current address at
____________ ______________ Dubai United Arab Emirates;

2. That my relationship with her is by consanguinity as my mother

______________________ and her father _______________ are siblings;

3. That I am attaching the following supporting documents as proof of

such fact:

 My certificate of live birth showing that my mother is

_____________________ -- Annex "A";

 The Certificate of Live Birth of ____________________ showing that

her father is _____________ -- Annex "B";

 The Certificate of Live Birth of __________________ showing that

his parents are ______________ and _______________ -- Annex "C";

 The Certificate of Babtism of ___________________ showing that

her parents are ________________ and _________________ -- Annex
"D"

 A certification of the fact of my marriage to ___________________

FUERTE from the Office of the City Civil Registrar of
_________________ -- Annex "E";

3. Further, also attached is a certification from the Office of the Punong

Barangay of Barangay ________________, City of ___________ that I and
___________________ are cousins (Annex "F") and that our parents are children
of _________________ and ____________________.

4. That I execute this Affidavit for the purpose of supporting my visit to

my cousin ___________________ in ________________ and to attest to the truth of
the above statements for all legal intents and purposes without any intent to
circumvent any of the existing laws and regulations.

In witness hereof, I hereby set my hand this _____ th day of

_________________, 20__, in _______________________________.
 ______________________________________
(Affiant)

SUBSCRIBED AND SWORN to before me this __ th day of

__________________________. Affiant exhibited to me her government issued
identification card as indicated above below her name.

NOTARY PUBLIC
Doc. No. ____________
Page No.____________
Book No. ____________
Series of _____________

ANNEX "A"
ANNEX "B"
ANNEX "C"
ANNEX "D"
ANNEX "E"
ANNEX "F"
ANNEX "G"