WE, ___________________ and _________________, both of legal age, Filipino, single (living together) and residents of _______________________________, after having been duly sworn to in accordance with law, depose and state THAT:
1. We have been living together as husband and wife under the same roof, continuously and without any interruption, since _________ or a period of more than five (5) years;
2. During our cohabitation and even until the present, we remain both of single status and, hence, there exists no legal impediment for us to marry each other;
3. We were blessed with one son named ___________________ who was born on _________________ in _____________________;
4. We are executing this affidavit to attest to the foregoing facts and for the purposes of contracting marriage without the need of securing the marriage license pursuant to the provisions of Article 34 of the Family Code of the Philippines.
IN WITNESS WHEREOF, we have hereunto set our hands this ___________________ in _______________ , Philippines .