AFFIDAVIT

I, JADE ANDRES, 18 years old, single, Filipino citizen, and a resident of Barangay 13 San Eugenio,
San Nicolas, Ilocos Norte, Philippines, after having been duly sworn to in accordance with the law, do
hereby depose and state THAT:
1. In line with the documentary requirements needed for the Palarong Pamasko 2022;
2. Growing up, it has always been a struggle to be part of a broken home where I alternatively live
with any of my parents;
3. But right now I am living with my mom and we are on the process of legally changing my
surname to hers;
4. It is for this reason that I’m not able to produce the necessary documents listed for the Palarong
Pamasko 2022;
5. I am executing this Affidavit to inform the organizer of Palarong Pamasko 2022, the Community
Affairs Office, and other concerned individuals;
6. I am also executing this Affidavit to attest to the truth of the foregoing statements and for all legal
intents and purposes it may serve.
IN WITNES WHEREOF, I have hereunto set my hand this 19 th day of October 2022 at Laoag City,
Philippines.

JADE ANDRES
Affiant