Republic of the Philippines )

___________________ )S.S.

AFFIDAVIT OF CIRCUMSTANCE OF SOLO PARENT

I, PRINSESITA A. SOLINA, a Filipino, married, with residential address at Block

26 Lot 79, Grand Acacia Grove, Brgy. Banay-Banay, Cabuyao, Laguna, after being
sworn to in accordance with law, depose and say that:

1. At the age of 27 years old (2007), I gave birth to my son, Kenshin A.

Solina, at Biñan, Laguna on September 10, 2007.

2. I and the biological father of my son were married on December 8, 2005

but our relationship was terminated when he went to another country to
work and he no longer communicate to us regularly.

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

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

IN WITNESS WHEREOF, I have hereunto set my hand this ______________

in ________________.

PRINSESITA A. SOLINA
Affiant
 SUBSCRIBED AND SWORN to before me this ___________ in
_______________ by affiant who presented to me her
____________________ issued on __________________.

Doc. No. _______;

Page No. _______;
Book No. _______;
Series of 2020.