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REPUBLIC OF THE PHILIPPINES

) S.S.

AFFFIDAVIT OF SOLO PARENT

I, _______________________, of legal age, ____, single , with


residence address at__________________, after being duly sworn, hereby depose
and state :

1. That I am the mother of certain minor named _____________ , an


incoming ____________, a certain private school ;
2. That my above-mentioned son is applying for
_____________________________________________________
__________

3. That I am a solo/single parent since ___ as the father of my son had already
abandoned us without providing any financial support since then;

4. That I am in sole custody and solo parent, exercising sole parental authority
over my son and providing him all his needs;

5. That I executed this affidavit to attest to the veracity of foregoing facts and for
purposes of _____________________provided by the government of the
Philippines.
IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of
__________, in_________.

_____________________________
Affiant

SUBSCRIBED AND SWORN TO, before me this _____ day of ________, in


_________, affiant exhibiting to me her valid TIN No. ______________, issued by
Bureau of Internal Revenue (BIR).

DOC. NO._____
PAGE NO._____
BOOK NO._____
SERIES OF