REPUBLIC OF THE PHILIPPINES )

) S.S.

AFFIDAVIT OF CIRCUMSTANCE OF SOLO PARENT

I, xxx, of legal age, single, a Filipino, and a resident of xxxx, after having
been duly sworn to in accordance with law, depose and state:
1. I am the biological mother of xxxx who was born on xxxx;

2. I and the biological father of my son never got married, in fact our
relationship was terminated even prior to me giving birth to my son and
have never communicated with each other ever since the separation;

3. I was thereafter left alone with the sole responsibility of parenthood but
with the guidance and help of my family and up to present, I am solely
providing for the needs of my son

4. I am executing this Affidavit to attest to the truth foregoing facts and for
the purpose of securing a Solo Parent ID and to receive the benefits
under the Solo Parents’ Welfare Act of 2000.

IN WITNESS WHEREOF, I have hereunto set my hand this

_______________________ in _______________________, Metro Manila, Philippines.

xxxx
Affiant

SUBSCRIBED AND SWORN TO before me this _______________________ in

_______________________, Metro Manila, Philippines, affiant exhibiting to me her
xxxx.
Doc. No.: ___; NOTARY PUBLIC
Page No.: ___;
Book No.: ___;
Series of 2019.