REPUBLIC OF THE PHILIPPINES)

CITY OF TAGBILARAN) S.S.

SWORN AFFIDAVIT OF SOLO PARENT

I, ANA MARIE P. MOYANI, Filipino, of legal age, single, and a

resident of Dao, Dauis, Bohol, Philippines, after having been duly sworn to
in accordance with law, do hereby depose and say:

1. That I am a bonafide resident of Dao, Dauis, Bohol, and that I am a

single mother of three children, namely:

a. MA. JAY-AN MOYANI, born on December 14, 2007 at Pototan,

Ilo-Ilo, Philippines;

b. DOMINIC MOYANI, born on May 26, 2013, at Pototan, Ilo-Ilo,

Philippines; and

c. ANAFLORA LEAH M. ALAGOS, born on November 16, 2019,

at Taytay, Rizal, Manila, Philippines;

2. That I and the biological fathers of my children never got married, I

am left alone with the sole responsibility of parenthood and parental care,
and that I am solely supporting and providing for the needs of my three
children;

3. That I hereby attest to the fact that I am a SOLO PARENT, and that
I am neither co-habiting with a partner nor exercising co-parenting with any
other person/s;

4. That I am executing this affidavit to attest to the truth of the

foregoing statements in support of my application/renewal for a SOLO
PARENT Identification Card, and for whatever other legal purpose it may
serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 15 th day

of December 2022 in Tagbilaran City, Bohol, Philippines.

ANA MARIE P. MOYANI

Affiant

SUBSCRIBED AND SWORN to before me 15th day of December

2022 in Tagbilaran City, Bohol, Philippines.