Republic of the Philippines)

Province of Masbate )
City of Masbate )
x----------------------------------x

AFFIDAVIT OF GUARDIANSHIP

I, Juan Dela Cruz, of legal age, Filipino, married and a resident of Brgy.
Tabuc, Mobo, Masbate, after having been duly sworn to in accordance with law,
hereby depose and state:

1. That I am the auntie and guardian of __________, 16 years old as he was born
September 20, 2002;

2. That the above mentioned minor is under my care and custody for
thirteen (13) years already;

3. That I am not an imbecile, insane, a vagrant or a vicious person or

a habitual drunkard or a habitual criminal, and have
not abandoned, neglected or refused to support said minor/s or caused
him/them to commit offenses against the law.

4. That I am executing this affidavit to attest to the truth of all the foregoing
statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this

_______________________________, Philippines.

JUAN DELA CRUZ

Affiant

SUBSCRIBED AND SWORN TO before me this ____________________________ at

Masbate City, Philippines.

Doc No. ____;

Page No. ____;
Book No. ____:
Series of 2018.