REPUBLIC OF PHILIPPINES )

CITY OF DAVAO ) S.S.

X --------------------------------------------------- X

AFFIDAVIT OF SINGLE BUT HEAD OF THE FAMILY

I, ______________________, single, of legal age, Filipino, and a resident of

Davao City, after having duly sworn to in accordance with law, do hereby
depose and state that:

1. I am single and had never been married with anyone;

2. That I was onbornFebruary 25, 1959 to

______________________ and ______________________;

3. That I am now
living with my biological brother,
______________________;

4. That I am executing this Affidavit to attest to the truth thereof

and for purposes of application as Roxas Night Market
Vendor.

IN WITNESS WHEREOF, I hereby affix my signature this ______ day of

_________, 2023 in Davao City.

_________________________________
Affiant

SUBSCRIBED AND SWORN TO before me this ____ day of ______, 2023 at

__________, affiant having executed to me his ________ issued in ________ on ________.

Doc. No. : ______

Page No. : ______
Book No. : ______
Series of : ______