Republic of the Philippines )

Province of Tarlac ) S.S.

Municipality of Capas )

AFFIDAVIT OF SOLO PARENT

I, JOSEPH S. CALASARA, of legal age, married, Filipino, and a resident

of Brgy. Manlapig, Capas, Tarlac, after having been sworn to in accordance with
law, hereby depose and state: THAT-

1. I am the father of JAIRUZ CARL MARCELO CALASARA, who was born

on March 07, 2013 at Concepcion District Hospital, Concepcion, Tarlac;

2. CLAUDINE S. MARCELO, the mother of my aforesaid children

abandoned me and our children sometime on 2015 and never returned. She
refused to return to us and cut off all communications as I discovered that
she is now living with another man;

3. I was thereafter left alone with the sole responsibility of parenthood but
with the guidance and help of my family and up to the present, I am solely
providing for the needs of my child;

4. I am executing this Affidavit to attest to the foregoing facts and for the
purpose of securing a Solo Parent ID and to be entitled to the benefits under
the Solo Parents’ Welfare Act of 2000.

IN WITNESS WHEREOF, I have hereunto set my hand this 20 th day of

December 2021 in the Municipality of Capas, Tarlac.

JOSEPH S. CALASARA
Affiant

SUBSCRIBED AND SWORN TO before me this 20 th day of December

2021 in the Municipality of Capas, Tarlac, Philippines, the affiant having
satisfactorily established his identity to me by exhibiting to me his Voter ID with
ID No. VIN 6904-012DA-K2990JSC10000, bearing his picture and signature.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of 2021.