REPUBLIC OF THE PHILIPPINES )

QUEZON CITY, METRO MANILA ) S.S.

AFFIDAVIT
(of Declaration of Self Employment)
I, ______________________________________, of legal age, married, Filipino, a
resident of ____________________________________ after having been subscribed to an
oath, depose and say that:

1. I am self-employed as I have no employer other than myself and derive

income from my physical and mental effors as:
________________________ from ____________ until present at ___________________.

2. My daughter, ___________________, being qualified for a scholarship grant from

_______________________ is applying for the said scholarship grant;

3. I execute this Affidavit to attest to the truth of the foregoing and for the
purpose of submitting this document as part of the requirement of my daughter’s
scholarship grant.

IN WITNESS HEREOF, I hereby set my hand this _____th day of _________________,

20__, in _______________________________.

______________________________________
(Affiant)

SUBSCRIBED AND SWORN to before me this __th day of

__________________________. Affiant exhibited to me his/her _______________________ as
indicated above below his name.

NOTARY PUBLIC
Doc. No. ____________
Page No.____________
Book No. ____________
Series of 2018.