REPUBLIC OF THE PHILIPPINES)

What City ) S.S

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AFFIDAVIT OF CIRCUMSTANCE OF SOLO PARENT

I, Iking, Filipino, of legal age, single, and a resident of No. 1 Del Sur Palumbanes, after
having been duly sworn in accordance with law, hereby depose and state that:

1. At the age of twenty-one (25), I gave birth to my son, Jian at Quezon City on
May 12, 2011;

2. That I and the biological father of my son never got married, in fact our
relationship was terminated before my son celebrated his 3rd birthday and
have ever communicated ever since our relationship terminated;

3. I was thereafter left alone with the sole responsibility of parenthood but with
the guidance and help of my family and up to present, I am solely providing
for the needs of my son;

4. That I am executing this Affidavit to attest the truth of the foregoing facts and
for the purpose of securing a Solo Parent ID and to receive the benefits under
the Solo Parents’ Welfare Act of 2000.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ____ day of

Feb 14, 2014 at Quezon City, Philippines.

_________________________________
Iking

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for

___________________ this ____ day of ________. Affiant personally came and
appeared with TIN ID issued by the Bureau of Internal Revenue, on _______ bearing his
photograph and signature, known to me as the same person who personally signed the
foregoing instrument before me and avowed under penalty of law to the whole truth of
the contents of said instrument.

Notary Public