Republic 

of the Philippines )
Province of Palawan )S.S.
City of Puerto Princesa )
  

AFFIDAVIT OF INDIGENCY

             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 desire to avail of the free legal service of the Public Attorney’s Office.

2.  That my monthly net salary/income is P____________. 

3. That I am executing this affidavit to entitle me to the desired legal services. 

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

of _____________ at ______________, Philippines.

                                                                                 ________________
                                                                                           Affiant
                                

 SUBSCRIBED AND SWORN to before me this ____ day of

___________ in _________, Philippines, and I have read and translated the
foregoing Affidavit in a dialect known and understood by him/her..

Doc No. :  _____                                                             

Page No.: ______                                           
Book No.: ______                                              
Series of 2022