Republic 

of the Philippines )
City of ______               ) S.S.
x--------------------------x

AFFIDAVIT OF GUARDIANSHIP

            I, _________________, of legal age, single/married/widow,

Filipino citizen, and presently residing at _____________________, after having
been duly sworn to in accordance with law, do hereby depose and say:

1.  That I am the ___(state relationship)__ and guardian of the following minor/s who

has / have an interest in the _______________  of the
late _________________________ payable by ________________;

Full Name of Minor/s               Date of Birth                   Age

       _______________                 _________                   ______  
       _______________                 _________                   ______  
       _______________                 _________                   ______  

2.  That the above mentioned minor/s is/are under my care and custody; 

3. That I am competent to receive in behalf of the said minor/s any amount/s due

him/them; and 

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

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

5.  That I am executing this affidavit to attest to the truth of all the foregoing statements
and for whatever legal purpose it may serve.

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

_______ 2014 at ______________, Philippines.

                                                                                    ________________
                                                                                                Affiant
                                

            SUBSCRIBED AND SWORN to before me this ____ day of ______ 2014 in

_________, Philippines, affiant exhibiting to me his/her competent evidence of identity
by way of _______________ issued at ___________ on ________________.

Doc No. :  _____                                                             

Page No.: ______                                           
Book No.: ______                                              
Series of 2017                                                                Notary Public