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REPUBLIC OF THE PHILIPPINES ) _______________________ ) S.S.

AFFIDAVIT OF SEPARATION
That I MA. JENE CECILIA RAGAZA , of legal age, with residence address at San Roque St. San Juan, Kalayaan, Laguna after having sworn in accordance with the law, depose and say:

1. That I am the lawfully wedded wife/husband of EDGARDO B. VELASCO 2. That I have been separated from my wife/husband for over one year and reconciliation is highly improbable, and that since the time we separated, I have been personally managing my own business affairs and separate properties, earnings deriving therefrom sufficient income for my family and personal needs. 3. That I purchased 1 unit of MITSUBISHI MIRAGE G4 on installment basis. 4. That I hereby attest to the truth of all the facts above stated to show consent of my spouse is not necessary or is waived, my capability to pay my obligation out of my own income, and that I have separate properties sufficient to secure my aforesaid obligations under the terms and conditions of the Chattel Mortgage contract I have signed in connection with the purchase of the aforesaid unit.

FURTHER AFFIANT SAYETH NAUGHT


MA. JENE CECILIA RAGASA

AFFIANT

SUBSCRIBED AND SWORN to me this _____________ day of ______________________ at ______________________________, affiant exhibiting to me her Residence Certificate No. 05568300 issued at Kalayaan, Laguna on January 15, 2013.

NOTARY PUBLIC

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