Republic of the Philippines )

City of Bacolod ) SS.

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AFFIDAVIT OF LOW INCOME

I, __________________, single, of legal age, Filipino and resident

of _____________________________ Philippines, after having been duly sworn to in
accordance with law hereby depose and state:

1. That I am the mother of ________________, who is applying for School

Subsidy/ School Scholarship.

2. I am a Freelancer with a monthly income of Ten Thousand Pesos (P10,000.00)

more or less for the taxable year 2022;

3. I am a single mom and my monthly income is barely sufficient to support my

two daughters and our daily needs/expenses;

4. That I am executing this affidavit to attest to the veracity of the above

statements and for the purpose of applying for tax exemption with the Bureau of
Internal Revenue which is a requirement for the application of my daughter
___________________ for School Subsidy/School scholarship.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____day of

July, 2023 at City of Bacolod, Philippines.

_____________________
Affiant
ID No._____________

SUBSCRIBED AND SWORN TO before me this ___ day of _______ at

_______________ affiant exhibited to me Identification Card No._______________,
issued at ____________________, Philippines.

Notary Public

Doc. No. .......

Page No. ......
Book No. ......
Series of 2023