Annex 3 Affidavit template

REPUBLIC OF THE PHILIPPINES )

City/Municipality of __________________) S.S.

AFFIDAVIT

I, _______________________, Filipino, of legal age, and resident of

__________________________________________________, after having been duly sworn to
in accordance with law, do hereby depose and state the following:

(Check the appropriate box and sign the cell beside your choice)
Relationship to (Name of Student) __________________________
Signature
______________________________________________________
Father
Mother
Guardian
Civil Status
Single/Solo parent
Married
Married, solo parent
Married, legally separated
Widow/widower
Source of Income
None
Informal employment (Tricycle/jeepney/pedicab driver,
manicurist, barber, etc.) please specify: __________________
__________________________________________________
Estimated average monthly income: P___________________
Micro/Small business (Sari-sari store, direct selling, etc.)
please specify: _____________________________________
_________________________________________________
Estimated average monthly income: P___________________
Support from a relative
Name: _________________________________
Relationship with relative: ____________________________
Amount of monthly support: P_________________

I am executing this affidavit to attest to the truth of the foregoing facts and statements and for
whatever purpose this may serve.

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

________, 2020 at ________________________, Philippines.
Annex 3 Affidavit template

_____________________________
AFFIANT

SUBSCRIBED AND SWORN to before me this ___ day of _______________, 2020 at

__________________, Philippines, Affiant exhibiting to me his/her ______________________
issued on _______________ and valid until _______________ .

_____________________________
NOTARY PUBLIC

Doc. No. :____;

Page No. :____;
Book No. :____;
Series of _____