STATUTORY DECLARATION



    I, ___________________________________, a Malaysian citizen,

married with residence and postal address at

_____________________________________________________________________

_____________________________________________________________________

do hereby solemnly declare under oath:

       1.  That I have been married to ______________________________
           since _______________;

       2.  That during the year _______, my wife was unemployed in 
           Malaysia and had no other income;
           
       3.  That during her unemployment, my wife has been dependent
           on me for financial support;

       4.  That I have executed this Statutory Declaration to confirm
           the unemployment of ______________________________________
           for _____________ (state year) in connection with her 
           application for exemption from Philippine travel tax.

           



                                                 _____________________
                                                         Affiant




SUBSCRIBED AND SWORN to before me this ____ day of ____________, 19___.



                                               ________________________
                                                 Commissioner of Oaths/
                                                  Notary Public
                                           (Please print name, address and
                                           affix signature and seal, if any)



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