I, _____, of legal age, single, Filipino citizen, and presently residing at _________, after having been duly sworn to in accordance with law, do hereby depose and say:
THAT I have never contracted any marriage in the Philippines or elsewhere and I remain SINGLE to this very day and hour;
THAT there is no legal impediment for me to contract marriage under the Philippine Laws;
THAT I am executing this Affidavit for the purpose of complying with the requirements relating to my forthcoming marriage to Pedro De La Cruz in Toronto;
THAT I declare that the statements made in this affidavit are true and correct and I am willing to bear all the legal responsibilities arising therefrom.
IN WITNESS WHEREOF, I have hereunto set my hand this _ of ____ 20____ at the Philippine Embassy, , __.