Republic of the Philippines )

Province of Occidental Mindoro ) S. S.

Municipality of Mamburao )

AFFIDAVIT OF SOLO PARENT

I, CLAIRE ANN HAZEL C. CUSTODIO, of legal age, Filipino, single,

and a resident of Barangay Balansay, Mamburao, Occidental Mindoro, after
having been sworn to an oath in accordance with law, do hereby depose and say:

1. That I am solo parent to my son namely Johan Adam Hernandez (6

years old);

2. That my relationship with the father of my child severed after three (3)
years of our cohabitation;

3. That since then, my son John Adam Hernandez is living with me in

our home in Barangay Balansay, Mamburao, Occidental Mindoro;

4. That I was left solo or alone with the responsibility of taking good care
and providing support for my children;

5. That I am not cohabiting with another partner or co parent at the

present;

6. That I am executing this Affidavit to attest to the truth and veracity of

the foregoing facts and for whatever legal purpose the same may
serve.

FURTHER AFFIANT SAYETH NAUGHT.

IN WITNESS WHEREOF, I have set my hand this 25th day of January

2024 at Mamburao, Occidental Mindoro.
CLAIRE ANN HAZEL C. CUSTODIO
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this this 25th day of

January 2024 at Mamburao, Occidental Mindoro, affiant exhibited to me her
Voters Id with No. 5106-0050B-F2791CCC20000.

ATTY. MEYNARD H. MAGSINO

Public Attorney II
Pursuant to RA 9406