AFFIDAVIT

I, (complete name), (citizenship), of legal age, (age), (civil status), residing at (complete
address), after being duly sworn to in accordance with law, depose and say:

1. That I am admitted for the (state the program you have applied for).
2. That I am currently applying for the (name of Scholarship) offered by the
Institute.
3. That I am married with an annual income of (annual income of applicant). I am
married to (name of spouse) with an annual income of (annual income of spouse).
*OR
That I am single with an annual income of (annual income of applicant).
4. That I certify that Mr. (complete name of father) & Mrs. (complete name of
mother) is the name of my father & mother respectively.
*Note: Indicate if working and how much parents earn annually. Or if non-
working or under pension, indicate how much is the monthly pension.
5. That our annual family income in (currency) amounts to (total annual income of
family).
*Note: Total annual income of Applicant and Spouse OR Applicant and
Parents
6. That I am executing this affidavit to comply with the requirement of the Institute
for the scholarship application.

Further affiant sayeth none.

IN WITNESS WHEROF, I have hereunto set my hand this (day) of (month) (year).

________________________
Affiant

________________________
NOTARY PUBLIC

Doc. No.__________
Page No._________
Book No._________
Series of _________