REPUBLIC OF THE PHILIPPINES

City/Municipality of Omhah_ )S.S.

AFFIDAVIT

L Agapito d o _ Filipino, of legnl age, and resident of San Lon Umingan foan qosihan
after having been duly swom to in accordance with law, do hereby depose and state the following

(Check the appropriate bax and sign the cell beside your choice)
Relationship to (Name of Student).
Signature
Aldred & man A. frado
Father
Mother

Guardian
Civil Status
Single/Solo parent
Married
Married, solo parent

Married, legally separated

Widow/widower
Source of Incomee

None

Intomal employment (Tricycle/jeepney/pedicab dri ver, manicurist, barber, etc.) please

specify

Estimated average monthly income: P_

Micro/Small business (Sari-sari store, direct selling, etc.) pleasespecify

Estimated average monthly income: P_

Support from a relative
Name: Lolita P. Prudo
Relationship with relative: MoH
Amount of nmonthly support: P , d66

I am executing this affidavit to attest to the truth of the foregoing facts and statements and for whatever purpose this may serve.

IN WITNESS WHEREOF, I have hereunto afixed my signature this day 2020 at

Philippines.

Prado
AFFIANT

SUBSCRIBED AND SwORN to before me this day o 2020 at Philippines, Alfiant

exhibiting to me his/her ISSued on and valid until_

NOTARY PUBLIC

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