REPUBLIC OF THE PHILIPPINES)

PROVINCE OF BUKIDNON) S.S

MUNICIPALITY OF )

AFFIDAVIT
I, , of legal age, Filipino, married and a resident of Bukidnon, after
having been sworn in accordance with law do hereby depose and say:

1. That I got married to on April 29, 1995 at

2. That after few years of living together as husband and wife, my

husband did an act against me which is in violation to R.A 9262,
which led to our mutual decision part ways.

3. That we have been separated for more than 23 years now. And that
I have been raising our children alone.

4. That I am executing this affidavit to support my claim as a solo

parent.

5. That I am executing this affidavit to attest to the veracity of the

foregoing facts and for whatever worth this may serve best.

IN WITNESS WHEREOF, I have hereunto affixed my hand this 29 th day

of April, 2022 at Pangantucan, Bukidnon, Philippines.

Affiant

SUBSCRIBED AND SWORN to before me this 29th day of April, 2022

at Pangantucan, Bukidnon, Philippines, affiant having exhibited to me her .

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