REPUBLIC OF THE PHILIPPINES )

PROVINCE OF RIZAL ) S. S.
Antipolo City )

AFFIDAVIT OF CIRCUMSTANCE OF SOLO PARENT

I, JANE REYES, of legal age, Filipino, single, with postal address

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

1. I am the biological mother of JUNJUN DELA CRUZ born on

April 21, 2004 and JUNE DELA CRUZ, born on September 29, 2010.

2. The biological father of my son JUNJUN, JUAN DELA CRUZ

and I got married on December 25, 2003. However, after one (1) year of
marriage, JUAN started showing thoughtlessness and indifference in the
performance of his obligation to his family. He would give financial
assistance but never on a regular basis and never the full amount, despite
the fact that he knew the needs of our son. Eventually, JUAN totally
abandoned me and his son.

3. Thereafter, I was left alone with the sole responsibility of

parenthood but with the guidance and help of my family and up to
present, I am solely providing for the needs of my son;

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 Parents’ Welfare Act of 2000 and for whatever
legal intent and purposes it may serve.

IN WITNESS WHEREOF, I hereunto affixed my signature this

______TH day of December 2018 at Antipolo City, Province of Rizal,
Philippines.

JANE REYES
Affiant

SUBSCRIBED AND SWORN to before me _______TH day of

December 2018 at Antipolo City. Affiant exhibiting to me her
__________________________________,

Doc. No. ____ NOTARY PUBLIC

Page No. ____
Book No. ____
Series of 2018