REPUBLIC OF THE PHILIPPINES )

SAN NICOLAS ILOCOS NORTE ) S.S.

AFFIDAVIT

I, _____________________, of legal age, Filipino citizen and a resident of

Brgy. ____________________________, after having been duly sworn to in
accordance with law, do hereby depose and state that:

That _______________________ is my daughter and is under my costudy

and care since birth because she has visual impairment;

That because of her visual impairment, she cannot open a bank account
alone and she needs assisstance to do such act;

That she needs to open the said account for the Social Security System
(SSS) require her when she applied for Sickness/ Maternity Benefit;

That for the purpose of openning an account, I stand as her guardian

under my parental care and custody and whatever responsibility or duties and
incidents to my being guardian, I will assume all the same;

That I am executing this affidavit to attest to the truth and for all legal
intents and purposes it may best served.

IN WITNESS WHEREOF, we have hereunto set our hands

this____________________________at __________________________.

_____________________________
Affiant
ID No._______________________
Issued by ___________________

SUBSCRIBED AN SWORN to before me this

___________________________________________ Philippines. Affiant exhibited to me
their identification card written below their names and signatures as
competent proof of their identities.

Doc No._____
Page No._____
Book No.______
Series of 2019