Republic of the Philippines )

City of Passi, Iloilo )S.S.

AFFIDAVIT OF GUARDIANSHIP

I, ANELYN TEJADA CAMACHO, of legal age, Filipino, married and with address at
Brgy. Nueva Union, Passi City, Iloilo after having been duly sworn in accordance with law,
depose and state:

1. That I am the legal guardian of the minor, KATHLEEN CLAIRE TEJADA MONTEFALCO
born on June 3, 2004, who have an interest in applying for the Department of Science and
Technology (DOST) scholarship;

2. That the above-mentioned minor is under my care and custody;

3. That I am competent to certify for the DOST scholarship of the said minor;

4. That I am not an imbecile, insane, vagrant, or vicious person or a habitual drunkard or

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

5. As such, I am executing this Affidavit to attest to the truth of the foregoing and for whatever
legal intents and purposes it may duly serve.

IN WITNESS WHEREOF, I have here unto set my hand this 24th day of December
2020 at the City of Passi, Iloilo, Philippines.

ANELYN TEJADA CAMACHO

Affiant

SUBSCRIBED and SWORN to before me this 24th day of December 2020 at the City
of Passi, Iloilo, Philippines, by affiant, known to me to be the same person who executed and
personally signed the foregoing instrument before me and avowed under penalty of law to the
whole truth of the contents of the said instrument.

Notary Public

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