REPUBLIC OF THE PHILIPPINES ]

MUNICIPALITY OF PANIQUI  ] S.S.

 
AFFIDAVIT OF INDIGENCY

I, _______________________, Filipino, of legal age, with residence and postal

address at Brgy. Hernando, Anao, Tarlac, after having been duly sworn to in
accordance with law, depose and states, that:

1. I am a solo parent and a bonafide resident of Barangay Hernando, Anao,

Tarlac;

2. Our family belong to the lower strata in life having no sufficient source of
income;

3. My gross income does not exceed an amount double the monthly

minimum wage of an employee;

4. Attached hereto are the Certification of Indigency issued by the barangay

concerned as well as the Office of the Municipal Social Welfare and
Development (MSWDO) marked as ANNEX A AND B;

5. I am executing this Affidavit to attest to the truthfulness of the foregoing

facts and for whatever legal purpose of it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 24th day of

June 2020 in Paniqui, Tarlac Philippines.

___________________________
Affiant
SUBCRIBED AND SWORN TO before me this 24th day of June 2020 in
Paniqui, Tarlac Philippines.

Doc. No. _____;

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