REPUBLIC OF THE PHILIPPINES)

QUEZON CITY ) S.S

AFFIDAVIT OF CIRCUMSTANCE OF SOLO PARENT

 
            I, Rheann Camille V. Bartolay, Filipino citizen, of legal age, and a
resident of 737 Quirino Highway San Bartolome Quezon City, after having been
duly sworn in accordance with law, hereby depose and say:

1. That on 30 June 2018, I gave birth to my son named Rico Bartolay at the
East Avenue Medical Center. I am ______ (__) years old during that time;

2. That I and the biological father of my son never got married and in fact,
he abandoned us upon learning that I am pregnant with his child;

3. That the biological father of my son never communicated with us since

he abandoned us and failed to give any form of support to his child;

4. That I was thereafter left alone with the sole responsibility of parenthood
but my son and I were able to survive with the help and guidance of my
family and up to present, I am solely providing for the needs of my son;

5. That I am executing this Affidavit to attest to 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.

____________________________
Rheann Camille V. Bartolay
AFFIANT

SUBSCRIBED AND SWORN TO BEFORE ME, this _________ day of

____________ 2022, in _________________________ affiant having exhibited to me
her Valid I.D. No. _______________.

Doc. No. _________

Page No. _________
Book No._________
Series No. 2022