Republic of the Philippines)

Quezon City ) S.S.

AFFIDAVIT OF SOLO PARENT

I, _______________ of legal age, Filipino, and currently residing at

________________, after having been duly sworn to in accordance with law,
hereby deposes and states, that:

1. That I, _______________, am a solo parent for my minor

child_______________ born on ________, attached and marker hereto as
Annex “A”;

2. That the _______ of my children does not attend the needs of our child
including financial support;

3. That I am solely acting as the parent of my child, shouldering all our daily
needs and giving all basic necessities;

4. That I am executing this affidavit to attest to the truth and veracity of the
above and for fraud and for whatever legal purpose it may serve;

5. Further Affiant Sayeth Naught.

IN WITNESS WHEREOF, I have hereunto set my hand this 20th day of

May, 2019 in Quezon City, Philippines.

________________________
Affiant

SUBSCRIBED AND SWORN, to before me this 20th day of May 2019 at

Quezon City. Affiant exhibiting to me her SSS ID with No. 33-4401557-0 bearing
her photograph and signature as competent proof of identity.