REPUBLIC OF THE PHILIPPINES) Province of____________________) S.S.

City/Municipality of_____________) x---------------------------------------x AFFIDAVIT OF SUPPORT FOR SELF SUPPORTING FOREIGNER STUDENT I, ________________(name of affiant)____________, _______ citizen, of legal age, [single]/ [married to _________(name of spouse)_________], and a resident of ___________________(address of affiant)_______________, after having been duly sworn in accordance with law, hereby depose and state: 1. That I traveled and came to the Philippines on a tourist visa; 2. That for the said purpose, I have sufficient financial capabilities with savings and assets to defray all my expenses during and for the duration of my stay in the Philippines; 3. That I warrant, undertake and guarantee to assume any and all expenses which I may incur while staying in the Philippines; 4. That there is no criminal case pending in court against me, nor have I been charged of subversion, rebellion, or insurrection, smuggling or drug use in any court in the Philippines; 5. That I will not be a liability or a public charge in this country; 6. That I am executing this to attest to the veracity of the foregoing statement and for stating categorically and under oath the truth and facts of the above information; 7. That finally, I am executing this for whatever legal intents and purposes it may serve. IN WITNESS WHEREOF, I have hereunto affixed my signature this ____th day of ____________ 20___ at ____________, Philippines.

_______________(signature)__________________ (Printed Name)

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for _________(City/Province)____________ this ____th day of ____________ 20___. Affiant personally came and appeared with _____________(Competent Evidence of Identity)______ issued by the _________(Government Agency)______ on ___(date)__ at ________(place)_________, bearing his photograph and signature, known to me as the

same person who personally signed the foregoing instrument before me and avowed under penalty of law to the whole truth of the contents of said instrument. Atty ___________________________________________ Notary Public Commission Serial No. ____________________________ Notary Public for _______(Province/City)______________ Until December 31, 20__ Office: ______________(address)____________________ Roll No. __________ IBP Lifetime Roll No. _________; __/__/__ ; _(Province)_ PTR No. _________ ; __/__/__ ; _(Province)_ MCLE Compliance Cert. No. __________; __/__/__

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