Republic of the Philippines)

Province of Isabela )S.S.

Municipality of Cabagan )
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AFFIDAVIT OF INSOLVENCY

I, AAA, of legal age, Filipino citizen and resident of Brgy. Ballacayu, San Pablo,
Isabela, after having been duly sworn to in accordance with law, do hereby depose and
state THAT:

1. I am the same person executing this affidavit;

2. I am insolvent and unable to pay the penalty of fine in the amount of THREE
THOUSAND (Php3,000.00) PESOS otherwise imposed by the Honorable 1 st
MCTC, San Pablo, Isabela, in the Criminal Case No. _____, because I am
unemployed and a member of indigent in our community. Attached hereto is
the copy of Certificate of Indigency issued at Barangay Ballacayu, San Pablo,
Isabela as Annex “1”;

3. I am executing the foregoing affidavit in order to attest to the veracity and

truthfulness of the above facts and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 1 st day of March

2021 at Cabagan, Isabela.

AAA
Affiant

SUBSCRIBED AND SWORN to before me on the date and place stated above.