REPUBLIC OF THE PHILIPPINES )

CITY OF SAN JOSE DEL MONTE

PROVINCE OF BULACAN ) S.S.

AFFIDAVIT OF SOLO PARENT

I, MANILYN GABUMPA PAGATPAT, a Filipino citizen of legal age,

single, residing at PUROK 7-C SKYLINE ROAD BARANGAY TUNGKONG MANGGA
CITY OF SAN JOSE DEL MONTE BULACAN, after being sworn to in
accordance with law, do hereby depose and state that:

1. I am applying for the benefits provided under the Solo Parent Act of
2000;

2. I am a solo parent as defined under section 3(a) of the Solo Parent

Welfare Act of 2000 as I am a parent left solo or alone with the
responsibility of parenthood.;

3. I acknowledge that my eligibility to the benefits provided under the

Solo Parent Welfare Act of 2000 shall immediately cease upon a
change in status circumstance as a solo parent.

4. I am executing this Affidavit to attest the truth of the foregoing facts

and for the purpose of securing a Solo Parent ID and to receive the
benefits under the Solo Parents’ Welfare Act of 2000.

IN WITNESS WHEREOF, I have hereunto set my hand this day of

in San Jose del Monte City, Province of Bulacan, Philippines

MANILYN G. PAGATPAT
AFFIANT

REPUBLIC OF THE
PHILIPPINES )
DASMARINAS,
CAVITE . . . . . . . ) S.S.
SUBSCRIBED AND SWORN TO before me this day of____
in San Jose del Monte City, Province of Bulacan, Philippines, affiant
exhibiting to me her competent evidence of identity indicated below her
printed name , bearing her picture and signature appearing therein.

AFFIDAVIT
NOTARY PUBLIC

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2022