REPUBLIC OF THE PHILIPPINES )

______________ )
X----------------------------------------------X

AFFIDAVIT OF SINGLE PARENT

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

______________________, after having been duly sworn in accordance with law do
hereby depose and state:

1. That I am the same person executing this affidavit;

2. That I am connected with Local Government Unit (LGU) of

___________________and holding the position Administrative Aide III;

3. That I begot a child and who was born on ________ was named __________;

4. That the above named minor was conceived and born outside wedlock;

5. That I am the sole person exercising custody and care over my daughter;

6. That the whereabouts of her biological father is unknown since _______;

7. That I am executing this affidavit to attest to the veracity of my statements and for
whatever legal purpose that this affidavit may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this __ day of June 2020 at
________________, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this __ day of June 2020 at _____________

affiant exhibiting to me her competent evidence of identity above-stated bearing her
photograph and signature.

Doc. No.
Page No. Notary Public
Book No.
Series of 2020