Republic of the Philippines )

CITY OF SAN PEDRO S.S

Province of Laguna
x-------------------------------------------x

AFFIDAVIT OF NO FIX INCOME

I, JOAN B. PELAGIO, of legal age, Filipino and with residential and post office address
at 1150 Cuyab, City of San Pedro, Laguna, City of San Pedro, Laguna, after having duly sworn
to according to law hereby depose and state;

1. That I am intending to apply for Scholarship offered by CONG. ARLENE B.

ARCILLAS;
2. That one of the requirements of the said scholarship is the copy/proof of the
Bureau of Internal Revenue (BIR) of my validated Income Tax Return which does
not exceed Php 360,000.00 per annum;
3. That the said requirement is not applicable since I am not filing my income tax
return (ITR) for the reason that I have no permanent source of Income;
4. That I am executing this affidavit to attest to the veracity of the statements
mentioned above, and as a requirement for SCHOLARSHIP;

IN WITNESS WHEREOF, I have hereunto set my hand this 20 th day of July, 2018
at the City of San Pedro, Laguna

JOAN B. PELAGIO
Affiant

SUBSCRIBED AND SWORN to before me this 20th day of July, 2018 in City of San Pedro,
Laguna. Affiant having exhibited to me his/her Barangay I.D with No. 2925 as competent proof
of identity.

Doc. No: ________

Page No.:________
Book No.:________
Series of 2018