Republic of the Philippines )

City of Roxas ) S.S.

x---------------------------------x

AFFIDAVIT OF GUARDIANSHIP

I DEBBIE B. DELDACAN of legal age, married, Filipino citizen and presently residing at Agbalo
Panay, Capiz after having been duly sworn to in accordance with the law, do hereby depose and say:

1. That I am the auntie and the guardian of the minor who have an interest in applying for a DOST
scholarship and for whatever legal intent.

Full Name of Minor Date of Birth

Jiit D. Bordones April 16, 2001

2. That the above mentioned minor is under my care and custody;

3. That I am competent to certify in behalf of their parents in their application for DOST scholarship
and for whatever legal purposes.

4. That I am not an imbecile, insane, or a vagrant or a vicious person or a habitual drunkard or a

habitual criminal, and have not abandoned, neglected or refused to support the said minor or cause
him to commit offense against the law.

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

IN WITNESS WHEREOF, I have hereunto set my hands this __________________ at Roxas

City, Capiz, Philippines.

DEBBIE B. DELDACAN
Affiant

SUBSCRIBED AND SWORN to before me this ______________________at Roxas City, Capiz,

Philippines. Affiant exhibiting to me her competent evidence of identity _________________

Doc No: _________

Page No. ________
Book No. ________ I
Series of 2018