Republic of the Philippines )

Province of Occidental Mindoro ) S. S.

Municipality of Mamburao )

AFFIDAVIT OF SOLO PARENT

I, JOSEFA S. INSIGNE, of legal age, Filipino, widow, and a resident of

Barangay Fatima, Mamburao, Occidental Mindoro, after having been sworn to
an oath in accordance with law, do hereby depose and say:

1. That I am solo parent to my daughter namely Dyan Trixie S. Insigne

( 22 years old)

2. That the father of my children TOMAS ALASTRE INSIGNE died on

November 10, 2011 at Mamburao, Occidental Mindoro;

3. That my daughter namely Dyan Trixie S. Insigne is living with me in

our home in Barangay Fatima, Mamburao, Occidental Mindoro;

4. That I was left solo or alone with the responsibility of taking good care
and providing support for my children;

5. That I am not cohabiting with another partner;

6. Through this Affidavit, I hereby declare under oath that I am the solo
parent and guardian and the one taking custody and providing
support of the above-mentioned child.

7. I am executing this Affidavit to attest to the truth and veracity of the

foregoing facts and for whatever legal purpose the same may serve.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have set my hand this 25 th January 2024 at
Mamburao, Occidental Mindoro.
JOSEFA S. INSIGNE
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 25th January 2024 at

Mamburao, Occidental Mindoro, affiant exhibited to me her National Id with
No. 4028-9239-1381-4826.

ATTY. MEYNARD H. MAGSINO

Public Attorney II
Pursuant to RA 9406