REPUBLIC OF THE PHILIPPINES)

PROVINCE OF ALBAY ) S.S.

TABACO CITY )
x------------------------------------------x

AFFIDAVIT OF GUARDIANSHIP

I, _________________, of legal age, single/married/widow, Filipino citizen, and presently

residing at _____________________, after having been duly sworn to in accordance with law,
do hereby depose and say:

1. That I am the ___(state relationship)__ and guardian of the following minor/s who has /
have an interest in the _______________ of the late _________________________ payable by
________________;
Full Name of Minor/s

_____________________________________________________

_____________________________________________________

_____________________________________________________
Date of Birth

_______________

_______________

_______________
Age

______________

______________

______________
2. That the above mentioned minor/s is/are under my care and custody;

3. That I am competent to receive in behalf of the said minor/s any amount/s due him/them;
and

4. That I am not an imbecile, insane, a vagrant or a vicious person or a habitual drunkard or a

habitual criminal, and have not abandoned, neglected or refused to support said minor/s or
caused him/them to commit offenses against the law.

5. That I am executing this affidavit to attest to the truth of all the foregoing statements and
for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ___________ 20____ in
____________, _____________, Philippines.

___________________________________

Affiant

SUBSCRIBED AND SWORN to before me, this ____ day of __________ 20____, in the City of
__________________, by ___________________ with Passport No.________________ issued
on __________________ at _____________.
 ATTY. ANTHONY CLARK A. GAPIDO
Notary Public Tabaco City
For the Province of Albay
Roll No. 83746
IBP OR No. 227570; June 13, 2022
PTR No. 8843533; July 13, 2022 at Tabaco City
MCLE: N/A (Newly Admitted to the Bar)
2nd Floor Coastal Building Rental, Purok 2,
Morales Street, San Roque,Tabaco City, 4511

Doc No.____;
Page No. 450;
Book No. 35 ;
Series of 2022