Republic of the Philippines )

Province of Albay
) S.s.
City of Legazpi
)

AFFIDAVIT OF INDIGENCY
I, ________________, of legal age, married and residing at Purok 9, Pinaric,
Legazpi City and having been duly sworn in accordance with law, depose and say:

1.

That I desire to avail of the free legal service of the ________________;

2.

That my monthly salary/ income is P 3,500;

3.

That I own a real property with an assessed value of P 69,120;

4.
That I have herein attached a Certificate of Indigency and an Assessors
Certificate of Landholdings;
5.
That I am executing this affidavit to entitle me to the desired legal
services.

IN WITNESS WHEREOF, I have hereunto affixed my signature this 5 th day of

October, 2016 in Legazpi City, Philippines.

__________________
Affiant

SUBSCRIBED AND SWORN TO before me this 5th day of October, 2016 in

Legazpi City, Philippines. Affiant exhibited to me his ________________ with No.
__________ issued on _____________ at ______________ known to me the same
person who executed the foregoing document.

WITNESS MY HAND AND SEAL on the date and at the place first above-written.