Republic of the Philippines

Province of S.s.
City/Municipality of

AFFIDAVIT OF INDIGENCY

I, Yen Warren P. Canoy of legal age, married to Judy B. Canoy. and residing at Km.
12 Merville Access Road Pasay City and having been duly sworn in accordance
with law, depose and say:

1. That I desire to avail the exemption from payment of legal fees.

2. That my monthly net salary/income is P0.00 (zero pesos).

3. That I have no other source of income for I had been terminated from my
job.

4. That due to the above-mentioned reasons, I belong the lower strata of life.
Attached herein is a Certificate of Indigency issued by the Barangay Captain
of Barangay of 201 zone 20 Pasay City; and my termination letter from my
previous employer.

5. That I am executing this affidavit to entitle me to exemption from payment of

legal fees and to declare the truth of the foregoing facts

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

, 20 , in the City of ,
Province of
.

Signature of Affiant

SUBSCRIBED AND SWORN to before me this day of ,

20 at
, and I have read and translated the foregoing
Affidavit in a dialect known and understood by him/her.

Doc No. __________;

Page No. _________;
Book No. _________;
Series of 2024.