AFFIDAVIT

I, (state your name), of legal age, ______ citizen, (civil status) residing at (complete
address). After being duly sworn to in accordance with law depose and say:

1. That I am admitted for the (state the program you have applied for)

2. That I am currently applying for the (name of Scholarship) offered by the

Institute.

3. That I am married to (spouse) with an annual income of ____________

4. That I certify that Mr._______________ & Mrs.__________________ is the

name of my father & mother respectively. (Indicate if working and how much
parents earn. Or if non-working or under pension and how much monthly
pension)

5. That our annual family income in (currency) amounts to ________.

6. That I am executing this affidavit to comply with the requirement of the

Institute for the scholarship application.

Further affiant sayeth none.

IN WITNESS WHEROF, I have hereunto set my hand this (day) of (month) (year).

________________________
Affiant

________________________
NOTARY PUBLIC

Doc. No.__________
Page No._________
Book No._________
Series of _________