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Republic of the Philippines )

City of Cabadbaran ) S.S.


x--------------------------x

AFFIDAVIT OF GUARDIANSHIP

I, CRESENTE E. JUSAYEN, of legal age, married, Filipino citizen, and


presently residing at P-9, Barangay Calamba, Cabadbaran City, Agusan del Norte,
after having been duly sworn to in accordance with law, do hereby depose and say:

1. That I am the grandfather and guardian of the following minors who have an
interest in applying for a DOST Scholarship and for whatever legal intent:

Full Name of Minor/s Date of Birth Age


KARLO J. AVENIDO August 24, 1999 17

2. That the above mentioned minors are under my care and custody;

3. That I am competent to certify in behalf of their parents in their application for


DOST Scholarship and for whatever legal purpose;

4. That I am not an imbecile, insane, a vagrant or a vicious person or a habitual


drunkard or a habitual criminal, and have not abandon ed, neglected or refused to
support said minors or caused them to commit offenses against the law.

5. That I am executing this affidavit to attest to the truth of all the foregoing
statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________


at Cabadbaran City, Agusan del Norte, Philippines.

CRESENTE E. JUSAYEN
Affiant

SUBSCRIBED AND SWORN to before me this ________________ at


Cabadbaran City, Agusan del Norte, Philippines, affiant exhibiting to me his competent
evidence of identity _____________________________.

Doc No. : ____


Page No.: ____
Book No.: ____ I
Series of 2017.
Republic of the Philippines )
City of Cabadbaran ) S.S.
x--------------------------x

AFFIDAVIT OF GUARDIANSHIP

I, ROSITA MAHINAY LOPEZ, of legal age, married, Filipino citizen, and


presently residing at Purok 1, Santiago, Agusan del Norte, after having been duly
sworn to in accordance with law, do hereby depose and say:

1. That I am the grandmother and guardian of KYLIE LOPEZ, who was born on
July 31, 2000, and is now 17 years old, who has an interest in applying for a
DOST Scholarship and for whatever legal intent;

2. That the above mentioned minor is under my care and custody;

3. That I am competent to certify in behalf of her parents in her application for


DOST Scholarship and for whatever legal purpose;

4. That I am not an imbecile, insane, a vagrant or a vicious person or a habitual


drunkard or a habitual criminal, and have not abandoned, neglected or
refused to support said minor or caused her to commit offenses against the
law.

5. That I am executing this affidavit to attest to the truth of all the foregoing
statements and for whatever legal purpose it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 24th day of


August 2017 at Cabadbaran City, Agusan del Norte, Philippines.

ROSITA MAHINAY LOPEZ


Affiant

SUBSCRIBED AND SWORN to before me this 24th day of August 2017 at


Cabadbaran City, Agusan del Norte, Philippines, affiant exhibiting to me her Voters ID
No. _______________________________.

Doc No. :
Page No.:
Book No.: I
Series of 2017