REPUBLIC OF PHILIPPINES)

MALOLOS CITY BULACAN)

AFFIDAVIT OF GUARDIANSHIP

We, LERGIE ORTEGA BASA and JAYPEE DELA IGLESIA BASA Both of
Legal age, Both Filipino citizen, Married and with postal and residence address at No. 71
N. De Galicia Street Maysan, Valenzuela City, after being duly sworn to in accordance
with law, depose and state:

1. That we are the legal guardian of;

Name Birthday Birthplace

IVY ANGCAJAS ORTEGA/ July 18, 2003/San Francisco, Quezon Province

2. That the parents of the above-named child was in the Quezon Province so they
can’t appear or sign at her school at Pamantasan ng Lunsod ng Valenzuela;

3. That we are the Legal Guardian of above-named minor since Two Years (2)
since 2019;

4. That the said minor is under our care and custody;

5. That we are not imbecile, insane, a vagrant or a vicious person or a habitual

drunkard or a habitual criminal, and have not abandoned, neglected or
refused to support said minor or caused him to commit offenses against the
law.

6. That we shall fully commit to guide and support the above-named minor in
her studies at Pamantasan ng Lunsod ng Valenzuela in accordance to its rules
and regulations.

IN WITNESS WHEREOF, I have hereunto set my hand on this day of

_______________ at MALOLOS CITY, BULACAN

LERGIE ORTEGA BASA JAYPEE DELA IGLESIA BASA

Affiant Affiant

SUBSCRIBED AND SWORN to before me this day of ___________ at

MALOLOS CITY, BULACAN

Doc. No. _____;

Page No._____;
Book No._____;
Series of 2021