I, __________,of legal age, Filipinos, single/married and residents of _____________, Dumaguete City, Negros Oriental on oath depose and say:
IN WITNESS WHEREOF, I have hereunto affixed my signature this _________________ in Dumaguete City, Philippines.
Affiant
SUBSCRIBED AND SWORN to before me, in the City of Dumaguete, Province of Negros Oriental, this ________________ by affiants exhibiting his valid identification and who appeared before me to have executed the foregoing affidavit of Consent.
Doc. No. ________; Page No. ________; Book No. _______; Series of 2022.