Republic of the Philippines )

Province of xxx ) S.c.

City of xxx )
x--------------------------------x

AFFIDAVIT OF GUARDIANSHIP
With Special Power of Attorney
I, MIKEL ROCES, of legal age, single and with residence and postal address
at xxxx, after being sworn to in accordance with law, depose and state:

1. That I am the uncle of the child named below who is a student of xxx
National High School xxx:

Name : ROGIE MIRAN ROCES

Date of Birth : January 1, 2000
Place of Birth: Metro Manila

2. That the parents of the above child, my nephew, left said child with us when
he was just an infant and since then his biological mother had not made
known to us her whereabouts;

3. That I am the guardian of the said minor since his childhood until present
having raised, nurtured and took care of him as our own child;

4. That am not an imbecile, insane, vagrant or a vicious person or a habitual

drunkard, and have not abandoned, neglected or refuse to support the said
minor or caused him to commit offenses against the law;

5. That I shall continue in committing to provide said minor, my nephew, the

guidance and support including his education the best I can;

6. That by way of Special Power of Attorney, I HEREBY APPOINT, NAME

AND CONSTITUTE, LETTY SAMSON, likewise a Filipino citizen, of legal
age, married and a resident of Brgy. xxx xxx, Leyte, to be my true and lawful
attorney-in-fact, for us and in my name, place, and stead, to do and perform
the following acts, to wit:

a. To process and sign all documents related to the Request for Correction
of Entries of Personal Information in the School Records with the
Department of Education Regional Office and other related institution
or government agencies;
b. To perform such other acts as may be deemed necessary to carry out the
foregoing acts/powers given by virtue hereof.

7. The Special Power of Attorney embodied herein shall not be repudiated

except by express writing from the principal;

8. I am executing this Affidavit with Special Power of Attorney based on my

personal knowledge and existing documents and out of my own free will and
act and deed;

9. I am executing this affidavit in good faith to attest to truth of the foregoing

facts and circumstances and for whatever legal purpose it may serve.

AFFIANTS FURTHER SAYETH NAUGHT.

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 IN WITNESS WHEREOF, we hereunto affixed our signatures this xxx at
xxx, Philippines.

MIC MIKEL ROCES

Affiant-Prinicipal
ID No. _______________________
Issued on/by: __________________

Accepted and conformed to by:

LETTY SAMSON
Attorney-in-fact/Agent

SUBSCRIBED AND SWORN TO before me this xxx in the City of xxx,

the above-named affiants exhibiting his competent proof of identity written below
his name. Known to me to be the same person who executed the foregoing affidavit
with SPA.

Doc No:______;
Page No: _____;
Book No: _____;
Series of _____.

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