Republic of the Philippines )

City of Muntinlupa ) S.S.

x--------------------------x

AFFIDAVIT OF INDIGENCY

I, _________________, of legal age, married, Filipino citizen, and presently

residing at _____________________, after having been duly sworn to in accordance with
law, do hereby depose and say:

1. That I desire to avail of the free legal service of the San Beda College Alabang School
of Law – Office of the Legal Aid.

2. That my monthly net salary/income is P____________.

3. That I am executing this affidavit to entitle me to the desired legal services.

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of _____________
at ______________, Philippines.

_________________

Affiant

SUBSCRIBED AND SWORN to before me this ____ day of ___________ in the City of
Muntinlupa, Philippines, and I have read and translated the foregoing Affidavit in
a dialect known and understood by her.

Doc No.: _____

Page No.: ______

Book No.: ______

Series of 2016