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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