Republic of the Philippines)

City …………….....) S.S.

AFFIDAVIT OF GUARDIANSHIP
I, _____________________, of legal age, Filipino, married, and a resident of Sambag I, Cebu
City, Philippines, after having been duly sworn to in accordance with law, hereby depose and say:

1. That I am the grandmother of ___________________ who was born on

____________________ to ____________________ and ____________________ at Las
Piñas City, Philippines;

2. That ____________________ is a transferee student of ____________________ as 3 rd Year

High School Level;

3. That one of the requirements in support of his transfer is the submission of the Certificate of
Live Birth issued by the National Statistics Office (NSO);

4. That since birth until present, the parents of ____________________ leave the care and
custody of their son to me, the father being my son;

5. That for almost sixteen (16) years, I have been the guardian of ____________________;

6. That I am executing this Affidavit of Guardianship in support of the application of Certificate

of Live Birth of ____________________ and to declare the truth of the foregoing facts and
for whatever legal 0

IN WITNESS WHEREOF, I have hereunto affixed my signature this

_______________________ at Cebu City, Philippines.

____________________
Affiant
Senior Citizen Identification Card No. _________
Issued on: ____________________
Issued at: ____________________

SUBSCRIBED AND SWORN TO before me on the above place and date. Affiant exhibited to
me her competent evidence of identity as shown above below her name.

Doc. No. ___;

Page No. ___;
Book No. ___;
Series of 2013.