REPUBLIC OF THE PHILIPPINES )

CITY OF BAGUIO
) S.S.
AFFIDAVIT OF CIRCUMSTANCE OF SOLO PARENT
I, _____________________, a Filipino citizen of legal age, single, residing at
_________________________ Baguio City, Benguet, after being sworn to in
accordance with law, depose and say that:
1.

At the age of ______ (__), I gave birth to my son, ___________ at

________________, Benguet on January 1, 2000;

2.

That I and the biological father of my son never got married, in fact
our relationship was terminated even prior to me giving birth to my
son and have ever communicated ever since the separation;

3.

I was thereafter 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.

IN WITNESS WHEREOF, I have hereunto set my hand this ___day of

__________ in Baguio City, Philippines
_____________________
Affiant SUBSCRIBED AND SWORN TO before me this _____ day of
__________ in Baguio City, Philippines, affiant exhibiting to me her competent
evidence of identity indicated below her printed name , bearing her picture
and signature appearing therein.