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Annex 3 Affidavit Template
Annex 3 Affidavit Template
AFFIDAVIT
(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.
_____________________________
AFFIANT
_____________________________
NOTARY PUBLIC