Republic of the Philippines ]
] S.S.
AFFIDAVIT
I, MARIA SANTOS, of legal, age, Filipino, married, with residence address at
___________________________________, after having been sworn to in accordance with law, hereby
depose and state that:
1. I am the legal wife of ALEX SANTOS (“Alex”) who was born on January 1, 1970. Hereto attached
as Annexes “A” and “B” made integral parts hereof are copies of Alex’s Birth Certificate and our
Marriage Certificate.
2. Alex and I have been separated in fact since _________________. Ever since the separation, I
have sought and was granted a favorable court order for financial support from Alex. The award
for support was granted by the Regional Trial Court of Quezon City, Branch __________.
However, I lost my copy of the said court order (“Court Order”).
3. Under the court order, Alex was directed by the court to give financial support to me and our two
children in the amount of PhP10,000.00 per month to be automatically debited from his payroll
account with Land Bank of the Philippines (“Land Bank”) Savings Account No.
___________________. The amount of PhP10,000.00 is then being credited to my Philippine
National Bank Savings Account No. ___________________.
4. Last February 2020, Alex resigned from his former employment and transferred to ABC
Corporation. This event caused the discontinuation of the financial support to me and my
children.
5. When I inquired with and sought assistance from Land Bank, I was required to resubmit the Court
Order to prove my claim. However, as mentioned, I lost the Court Order.
6. I am thus executing this affidavit to attest to the existence of the Court Order and the fact of the
obligation of Alex to financially support me and our children in the amount of PhP10,000.00 per
month.
7. I am likewise executing this affidavit to comply with the requirement of Land Bank for the afore
mentioned purposes and for whatever purpose/s that this may serve.
FURTHER AFFIANT SAYETH NAUGHT.
IN WITNESS WHEREOF, I have hereunto set my hand this ___ day of
______________ 2020 at _____________________.
MARIA SANTOS
Affiant
SUBSCRIBED AND SWORN to before me this ___ day of ______________ 2020,
affiant exhibited to me her ____________________________.
NOTARY PUBLIC
Until December 31, 20____
Doc. No.______
Page No.______
Book No.______
Series of 20_____.