REPUBLIC OF THE PHILIPPINES)

PROVINCE OF AURORA ) S.S.

MUNICIPALITY OF SAN LUIS )

AFFIDAVIT OF A BARANGAY OFFICIAL

THAT A SOLO PARENT IS A RESIDENT OF THIS BARANGAY

I, ____________________________, Filipino, of legal age, _____________________

(marital status), and a resident of Barangay _______________, San Luis, Aurora,
Philippines, after being sworn to in accordance with law, depose and state:

1. I am the incumbent Punong Barangay of ________________, San Luis,

Aurora;

2. I attest that __________________________________ (Full Name of Solo

Parent Applicant) is presently residing at Barangay _______________,
San Luis, Aurora;

3. That upon verification, he/she provides sole parental care and support to
the following Child/Children:

NAME DATE OF BIRTH AGE

1.
2.
3.
4.
5.

4. That this Affidavit is being issued upon the request of aforementioned

Solo Parent Applicant for the authentication of his/her eligibility as Solo
Parent as required by Revised Implementing Rules and Regulations of
R.A. 8972, As Amended by R.A. 11861.

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

____________ 2023 in San Luis, Aurora, Philippines.

_____________________________
Affiant

SUBSCRIBED AND SWORN to before me this ________ day of ___________

2023, by affiant ________________, with ID ______________________, and who
personally signed before me the foregoing AFFIDAVIT OF BARANGAY
OFFICIAL THAT A SOLO PARENT IS A RESIDENT OF THIS BARANGAY and
acknowledged that they executed the same.

Doc. No. _________;

Page No. ________ ;
Book No. ________;
Series of 2023.