Sample Affidavit of Solo Parent

REPUBLIC OF THE PHILIPPINES ) CITY OF BAGUIO ) S.S. AFFIDAVIT OF CIRCUMSTANCE OF SOLO PARENT

I, _____________________, a Filipino citizen o le!al a!e, "in!le, #e"i$in! at  %%%%%%%%%%%%%%%  %%%%%%%%%%%%%%%%%%%%%%% %%%%%%%%%% %% Ba!&io Cit', Ben!&et, ate# (ein! "o#n to in acco#$ance it* la, $epo"e an$ "a' t*at+ .

At t*e a!e o %% %%%%%% -%% -%%), I !a !ae (i# (i#t* to /' /' "on "on, %%%%%%%%%%% at  %%%%%%%%%%%%%%%  %%%%%%%%%%%%%%%%, %, Ben!&et on on 0an&a#' , , 12223

1.

T*at I an an$ t* t*e (i (iolo! lo!ical at* at*e e# o o /' /' "o "on ne nee# e# !ot /a# /a###ie$, in ac actt o&# #elation"*ip a" te#/inate$ een p#io# to /e !iin! (i#t* to /' "on an$ *ae ee# co//&nicate$ ee# "ince t*e "epa#ation3

4.

I a a" t*e t*e##ea eate# te# le lett alo alone ne it* it* t*e t*e "o "ole #e"po e"pon" n"i( i(il ilit it' ' o o pa# pa#en ent* t*oo oo$ $ (&t it* t*e !&i$ance an$ *elp o /' a/il' an$ &p to p#e"ent, I a/ "olel' p#oi$in! o# t*e nee$" o /' "on3

5.

I a/ a/ e6 e6ec& ec&tin tin! t* t*i" A7 A7$ait it to to att atte" e"tt to to t* t*e o# o#e e!oin! in! ac act" t" an$ o o# t*e p&#po"e o "ec&#in! a Solo Pa#ent I8 an$ to #eceie t*e (ene9t" &n$e# t*e Solo Pa#ent": ;ela#e Act o 1222.

IN ;ITNESS ;HEREOF, I *ae *e#e&nto "et /' *an$ t*i" %%%$a' o  %%%%%%%%%%  %%%%%%%%%% in Ba!&io Ba!&io Cit', P*ilippine" P*ilippine" _____________________

A7ant SUBSCRIBE8 AN8 S;ORN TO (eo#e /e t*i" %%%%% $a' o  %%%%%%%%%%  %%%%%%%%%% in Ba!&io Ba!&io Cit', P*ilippine", P*ilippine", a7ant a7ant e6*i(itin! e6*i(itin! to /e *e# *e# co/petent co/petent ei$ence o i$entit' in$icate$ (elo *e# p#inte$ na/e , (ea#in! *e# pict&#e an$ "i!nat&#e appea#in! t*e#ein.