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SWORN AFFIDAVIT:

PHILIPPINE CITIZENSHIP

REPUBLIC OF THE PHILIPPINES )


Consulate General of the Philippines ) s.s.
New York, New York )

SWORN AFFIDAVIT
(Philippine Citizenship)

I, ______________________________________________________, Filipino, of
legal age, single / married to ______________________________________, and a
resident of __________________________________________________________
(complete address), after having been duly sworn in accordance with law, hereby
voluntarily depose and say:

I am a Filipino citizen at the time of this Passport Application and therefore I am


eligible for a Philippine Passport.

Under penalty of perjury, I declare that the above statement is true and correct to
the best of my knowledge and belief.

I am executing this affidavit fully aware that I will be subject to corresponding


criminal, civil and administrative liabilities, including being blacklisted as an
inadmissible foreign national, for any fraud or misrepresentation on my Filipino
citizenship

SIGNED on ____________________________________ in New York City.

____________________________________
AFFIANT

SUBSCRIBED AND SWORN TO before me this day of ___________________


in the City of New York.

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