REPUBLIC OF THE PHILIPPINES)

PROVINCE OF BUKIDNON) S.S.

MUNICIPALITY OF PANGANTUCAN)

AFFIDAVIT
(Re: SOLO PARENT)
I, , of legal age,Filipino citizen, single and a resident of Bukidnon, after being
duly sworn to in accordance with law, do hereby depose and say:

1. That I am the solo parent of , who was born on June 28, 2021, at
Southern Hospital,, Bukidnon;

2. That her father abandoned me after giving birth for more than two (2)
years already, I was left solo and alone with the responsibility of taking
good care and providing support for our above-named daughter;

3. That as of the moment, I am not cohabiting with any other partner;

4. That I am executing this affidavit to the fact of being a solo parent and to
facilitate my request to be registered in the proper authorities as such;

5. Furthermore, I am executing this affidavit to attest to the veracity of the

foregoing facts and for whatever worth this may serve best.

IN WITNESS WHEREOF, I have hereunto affixed my hand this 10th day of

January, 2024 at Pangantucan, Bukidnon, Philippines.

Affiant

SUBSCRIBED AND SWORN TO before me, this 10th day of January, 2024 at
Pangantucan, Bukidnon, Philippines, affiant having exhibited to me her Solo Parent
ID No..

Doc No.
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Series of 2024