Republic of the Philippines . . . .

)
Municipality of Alabel . . . . . . . . ) S. S.
Province of Sarangani . . . . . . .)
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AFFIDAVIT OF INDIGENCY

I, CONCHITA CABCA UGOS, of legal age, Filipino, married and a

resident of Brgy. Ampon, Malungon, Sarangani Province, after having been
duly sworn to in accordance with law, depose and state:

1. That I belong to the lower strata in life having no sufficient source of

income;

2. My gross income do not exceed an amount double the monthly

minimum wage of an employee;

3. Attached hereto is the Certificate of Indigency from the Office of the

Punong Barangay having jurisdiction over my residence as Annex
“A”;

4. That I execute this affidavit and to attest to the veracity of the

foregoing facts and statements and for whatever legal purposes this
may serve best.

IN WITNESS WHEREOF, I hereby affix my signature this 05th day of

April 2018, in Alabel, Sarangani Province.

CONCHITA C. UGOS
Affiant

SUBSCRIBED AND SWORN to before me this day of

2018, in Alabel, Sarangani Province. I HEREBY CERTIFY that I have
personally examined the herein affiant and that I am fully satisfied that he
voluntarily executed and understood his affidavit.