REPUBLIC OF THE PHILIPPINES)

_________________________) S.S.

AFFIDAVIT OF UNEMPLOYMENT

I, _______________________, Filipino, of legal age, and resident of

__________________________________________________, after having been duly sworn to
in accordance with law, do hereby depose and state the following:

(Check the appropriate box and sign the cell beside your choice)
Relationship to (Name of Student) __________________________
Signature
______________________________________________________
Father
Mother
Guardian
Civil Status
Single/Solo parent
Married
Married, solo parent
Married, legally separated
Widow/widower
Source of Income
None
Informal employment (Tricycle/jeepney/pedicab driver,
manicurist, barber, etc.) please specify: __________________
__________________________________________________
Estimated average monthly income: P___________________
Micro/Small business (Sari-sari store, direct selling, etc.)
please specify: _____________________________________
_________________________________________________
Estimated average monthly income: P___________________
Support from a relative
Name: _________________________________
Relationship with relative: ____________________________
Amount of monthly support: P_________________

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 affixed my signature this ___ day of

________, 2019 at ________________________, Philippines.
 _____________________________
Affiant

SUBSCRIBED AND SWORN to before me this this ___ day of ________, 2019 at
____________________, Philippines. I hereby certify that I have personally examined the
above-named affiant, who confirmed to me that he/she has voluntarily executed the above
affidavit and understood the contents thereof.

Doc. No. ____

Page No. ____
Book No. ____
Series of ____