REPUBLIC OF THE PHILIPPINES)

CITY OF BAGUIO ) S.S.

AFFIDAVIT OF CIRCUMSTANCE OF SOLO PARENT

I, GERALDINE BUGNAY TAKINAN, a Filipino citizen of legal age, single, residing at

Gangeb, Tadiangan, Tuba, Benguet, after being sworn to in accordance with law, depose and
say that:

1. At the age of nineteen (19), I gave birth to my daughter, Zoe Keith Takinan Flores at
Benguet General Hospital, La Trinidad, Benguet on September 11, 2000;

2. That I and the biological father of my daughter never got married, in fact our relationship
was terminated several years from now and have never communicated ever since the
separation;

3. I was thereafter left alone with the sole responsibility of parenthood but with the
guidance and help of my family up to present, I am solely providing for the needs of my
daughter;

4. I am executing this Affidavit to attest the foregoing facts and for the purpose of my
daughter’s application for Special Program for the Employment of Students (SPES) in
the Municipality of Tuba, Benguet.

IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of March 2022 in
Baguio City, Philippines.

GERALDINE BUGNAY TAKINAN

VIN: 1113-0082A-C2081GBT20000
Solo Parent ID No. 295

Affiant SUBSCRIBED AND SWORN TO before me this 16th day of March 2022 in Baguio
City, Philippines, exhibiting to me her competent evidence of identity indicated below her printed
name, bearing her picture and signature appearing therein.

Doc. No. _____

Page No. _____
Book No. _____
Series 2022