Republic of the Philippines )

___________……………………)SS.
x-------------------------------x

AFFIDAVIT OF GUARDIANSHIP

I, ______________________, of legal age, Filipino and a resident of

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

1. That I am the guardian/custodian of the minor named

___________________, who was born on ______________ at
__________________________, to his/her biological parents
_________________ and ______________________;

2. That the said child has been under my guardianship and custody for
________ months/years because ___________________________;

3. That I am the only one been providing/supporting her basic needs; And,

4. That I am executing this Affidavit to attest the truthfulness of the

foregoing statements and for whatever legal purpose this may serve;

IN WITNESS WHEREOF, I do hereby set my hand this

___________________ in _________________________.

________________
Affiant

SUBCRIBED AND SWORN to before me this _________________ in

______________________. Affiant appeared before me, exhibited to me her
___________________ ID No. _____________ issued by __________________
and is personally known to me.

NOTARY PUBLIC