Republic of the Philippines

Province of Laguna
Municipality of Lumban
BARANGAY STO. NIÑO

Office of the Punong

Barangay
AFFIDAVIT OF SOLO PARENT

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

of ____________________, _______________________, Philippines, after having been
duly sworn to in accordance with law, hereby depose and state:

That, I am the biological mother of _____________ who was born on

__________________ at ___________________, ____________________-;

From the time we separated up to present, I am left alone performing the essential
parental obligation over my daughter. My partner/husband did not give any
financial support to our daughter/son;

I am executing this affidavit to attest to the foregoing facts and for the purpose of
securing a Solo Parent ID and to receive the benefits under the Solo Parent’s Welfare
Act of 2000.

IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of July 2024 at
__________________________, Philippines.

_________________________________
Affiant

SUBCRIBED AND SWORN TO before me this 8th day of July 2024 at

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

Certified by:

Hon. EFREN R. LEGISMA JR.

Punong Barangay