Republic of the Philippines )

____________ ) S.S.

AFFIDAVIT OF SOLO PARENT

I, ___________________, of legal age and a resident of

___________________________________, after being duly sworn according to law,
hereby depose and state that:
1. I am the mother of the following children:

a. ______________________ who was born on ________________;

b. ______________________ who was born on ________________;

c. ______________________ who was born on ________________,

and;

d. ______________________ who was born on _______________, all

born in _____________, Philippines;

2. As the solo parent of the above-named children, I applied for and was issued
a Solo Parent ID with ID No. __________ by the Social Welfare and
Development Office of _____________, a photocopy of which is hereto
attached as ANNEX “A;”

3. The said Solo Parent ID was issued on _______________ with the one -year
validity or until _____________;

4. I am executing this Affidavit for the purpose of processing the renewal of my

Solo Parent ID with Social Welfare and Development Office of __________,
and;

5. I am executing this Affidavit to attest to the truth of the foregoing statements

to use the same for whatever legal purpose it may serve.

AFFIANT FURTHER SAYETH NAUGHT.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of

____________ 202_ at _____________.

__________________________
Affiant
(ID Presented)
 SUBSCRIBED AND SWORN to before me in __________, Philippines, this __
day of ________ 202_ by the above-named affiant, who has satisfactorily proven to me
her identify through her competent evidence of identity as indicated below her name
and signature.

WITNESS MY HAND AND SEAL.

Doc. No. ___;

Page No. __;
Book No. _;
Series of 202_.