REPUBLIC OF THE PHILIPPINES )

________________ CITY ) S.S.

AFFIDAVIT OF SOLO PARENT

I, XXX, of legal age, single, Filipino with postal address

at xxx, after having been duly sworn to in accordance with
law, hereby deposes and states that:

1. I am the biological mother of xxx who was born on

xxx and a minor, xxx who was born xxx;

2. I begot xxx and xxx out of wedlock;

3. Since xxx and xxx were born, I am the only one who
raise them and provide their necessities;

4. At present, I am working as a Call Center Agent in

order to earn money so I can raise my children on my own;

4. I hereby execute this Affidavit to attest to the truth

and veracity of the foregoing facts and for whatever legal
intents and purpose it may serve, in relation to the Solo Parent
Act (R.A. 8972).

IN WITNESS WHEREOF, I have hereunto set my hand

this xxx at xxx.

XXX
Affiant