REPUBLIC OF THE PHILIPPINES }

MAMBUSAO, CAPIZ } S.S.

AFFIDAVIT OF GUARDIANSHIP

I, MILAGROS F. FERRER, of legal age, Filipino, married, and resident of Sto.

Rosario, Jamindan, Capiz after having been sworn in accordance with the law, hereby, depose
and state:

1. I am the grandmother and guardian of, KEITH IRISH G. FRRER, born on March 18,
2005, who has an interest in applying for the Department of Science and Technology
(DOST) scholarship;

2. That the above-mentioned applicant is under my care, custody, and support;

3. That I am competent to certify for the DOST scholarship of the said applicant;

4. That I am not an imbecile, insane, vagrant, or vicious person or a habitual drunkard or

a habitual criminal, and have not abandoned, neglected, or refused to support the said
applicant or cause her to commit offenses against the law;

5. I am executing this Affidavit to attest to the truth of the foregoing and for whatever
legal purposes it may duly serve.

IN WITNESS WHEREOF, we have hereunto set our hands this ____________ in

Mambusao, Capiz, Philippines.

MILAGROS F. FERRER
Affiant
OSCA I.D No. 0022537

SUBSCRIBED AND SWORN TO before me this _________ at Mambusao, Capiz,

Philippines, by the affiants who exhibited to me their competent proof of identities indicated
below their names and signatures.

Doc. No. _____;

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