REPUBLIC OF THE PHILIPPINES)

CITY OF _______________- ) S.S.

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

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:

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

__________________ at ___________________, ____________________-;

2. That, I and the biological father of my daughter never got married. We cohabited
for about ______________ year but since _______ we have completely separated our
ways;

3. From the time we separated up to present, I am left alone performing the

essential parental obligation over my daughter. My common-law husband did not give
any financial support to our daughter;

4. 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 19th day of June
2019 at __________________________, Philippines.

_________________________________
Affiant

SUBCRIBED AND SWORN TO before me this 19th day of June 2019 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.

Doc. No. _____;

Page No. _____;
Book No. _____;
Series of 2019.