Republic of the Philippines }

Alaminos City, Pangasinan } S.S.

AFFIDAVIT OF TWO DISINTERESTED PERSONS

WE, _____________________ and ________________________, Filipino

citizens, both of legal age, and residents of ___________________,
__________________, after having been duly sworn to in accordance with law,
hereby depose and say that:

1. That we personally know _______________________, who is our long-

time neighbor in ________________, ______________, ________________;

2. That we know for a fact that ______________________ has ____ (_)

children, namely: _______________;

3. That sometime on _____ the biological father of her child left them for
unknown reasons;

4. That after he left, we know for a fact that ______________________

acted as a solo parent to handle all responsibilities of parent and solely providing
for the needs of her children;

5. That we are executing this affidavit in order to attest to the truth of the
facts aforementioned, and for any other legal purpose this may serve.

IN WITNESS WHEREOF, we have hereunto set our hand this ____ day of
_____ 2023 at ___________________.

__________________________ __________________________
AFFIANT AFFIANT

SUBSCRIBED AND SWORN to before me, this ____day of ________

2023, at __________________ by the affiants, who have satisfactorily proven to
me their identity through competent evidence of their identities indicated below
their names and signatures.

Doc No. ___;

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