Republic of the Philippines )

Cainta, Rizal ) SS.

AFFIDAVIT OF SOLO PARENT

I, ____________________________________________, Filipino, of legal age and a

resident of _________________________________________________________________,
under oath, do hereby depose and state, that:

I am the mother/father of the herein below named child/children, to wit:

NAME DATE/ PLACE OF BIRTH

1. _________________________________ _______________________________;
2. _________________________________ _______________________________;
3. _________________________________ _______________________________;

I am a solo parent since _____________________ due to the following

circumstances:
___________________________________________________________________________
___________________________________________________________________________
_____________________________________________________

Due as aforesaid, I am exercising sole parental authority over my above-named

child/children and been the sole provider of all his/her/their needs;

This affidavit is being executed to attest to the veracity of the foregoing statements in
order to establish the fact that I am considered as a single parent due to circumstances
mentioned above and in compliance with the documentary requirements of the Municipal
Social Welfare and Development Office - Cainta, Rizal for my application or for the renewal
of my Solo Parent ID for purposes not contrary to law, morals, good customs and public
policy.

IN WITNESS WHEREOF, I have hereunto set my hand and respective signature this
_________________ in Cainta, Rizal.

________________________________
Name & Signature
ID No. __________________________
Issued by: ______________________

SUBSCRIBED AND SWORN TO before me on the date and at the place above-written.

Doc. No. _____ ;

Page No. _____ ;
Book No. _____ ;
Series of 2023.