REPUBLIC OF THE PHILIPPINES)

PROVINCE OF LAGUNA
MUNICIPALITY OF KALAYAAN ) S.S.

AFFIDAVIT OF SOLO PARENT

I, ______________________, Filipino, of legal age, single and a resident of

_______________, ________________, Philippines, after having been duly
in accordance with law, hereby depose and state:
1. That, l am the biological mother of_____________________________
who was born on ___________ at _____________, _________________ ;
2. That the aforesaid child is under my mother’s care and custody since his
birth.
3. That his biological father and I separated way in year ______, I was
thereafter left alone with the sole responsibility of parenthood but with
the guidance and help of my family and up to present, I am solely
providing for the needs of my son;
4. That I am executing this affidavit to attest the truth of the foregoing
statements that and for whatever legal purposes it may serve.

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

________________at _______________, _______________ Philippines

________________________
Affiant

SUBCRIBED AND SWORN TO before me this ______ day of

________________ at _______________, _______________ Philippines
affiant exhibiting to me competent evidence of her identity and she is
known to me to be the same person who executed the foregoing affidavit.