AFFIDAVIT OF LOW INCOME

I, ________________, of legal age, Filipino, and a resident of

________________________________, after having been sworn to in accordance with law,
hereby depose and say, that:

1. I am the guardian of Abby Claire M. Forteza;

2. She is a graduating K-12 student and incoming first year college at DHVSU, Pampanga;

3. Her parents, Romeo Forteza and Marisa Forteza, are not present to attend to these
matters. Nonetheless, a Certificate of Indigency has been issued by the Office of the
Punong Barangay of Brgy. San Agustin, Arayat, Pampanga;

4. Their annual income is only Php 36,000.00, which is so meager and only enough to cover
their daily needs;

5. I am executing this Affidavit of Low Income to attest to the truth of the foregoing and for
whatever legal purpose that this Affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this ____________ at City of

San Fernando, Pampanga.

___________________
Affiant

SUBSCRIBED AND SWORN to before me, _____________ at City of San Fernando,

Pampanga. Affiant exhibiting to me his/her competent proof of identity ______________ issued
at _______________ on ______________.

Doc. No. ____

Page No. ____
Book No. ____
Series of 2024