AFFIDAVIT

(Solo Parent)
I _____________________________ of legal age, Filipino, and are presently
residing at ________________________________________________________________,
Quezon Province, Philippines, after being sworn to in accordance with law,
hereby depose and state:

1. I am the MOTHER / FATHER of _____________________________

who was born on _______________________ at
__________________________.

2. That his biological mother/ father ______________________________;

3. I am now separated with his/ her mother / father for almost

___________ (____) years now. Since _______, he/ she abandoned us
without providing any financial support to our child and I was left
solo or alone with responsibility of taking good care and providing
support for our child.

4. Thus, through this Affidavit, I hereby declare under oath that I am

the solo parent and guardian and the one taking custody and
providing support of the above-mentioned child/ children.

5. In view of the foregoing, I believe, I am qualified for the benefits

provided under the EXPANDED SOLO PARENTS WELFARE ACT
as I am a parent left solo or alone with the responsibility of
parenthood due to the abandonment of my child/children’s
mother / father.

7. As such, I am executing this Affidavit to:

a) Attest the truthfulness of the foregoing
statements;
b) Support my application to avail all Solo
Parent benefits & privileges under the law
and/or for the renewal of my Solo Parent
Identification Card and Booklet
c) and for whatever legal purposes it may serve.

FURTHER AFFIANT SAYETH NAUGHT.

_____________________________

Affiant

Govt. Issued ID No.: ____________

Issued on: ______________________

Issued at: ______________________

SUBSCRIBED AND SWORN to me before this ___ day of JULY 2023 at

Candelaria, Quezon, affiants exhibited to me his/her government issued ID/s
written below his/ her name.
Doc. No. ___;
Page No. ___;
Book No. ___;
Series of 2023.