Republic of the Philippines}

Ormoc City } S.S

AFFIDAVIT OF NON-FILING OF INCOME TAX RETURN

I, HAZEL MAE S. LEGASPI, of legal age, Filipino, and a resident of Brgy. Doa Feliza, Ormoc City, and under oath,
hereby depose and state:

1. That I am the mother of HARRIETTE MAE L. LABRADA;

2. That my said daughter is currently enrolled as Grade 12 student at Western Leyte College, Ormoc
City;

3. That my said daughter is applying for Scholarship Program under the CHED Student Financial
Assistance program for school year 2018;

4. That one of the requirements for said scholarship program is a proof of the Bureau of Internal
Revenue (BIR) validated Income Tax Return (ITR) of parents/guardian;

5. That I did not file my ITR at the BIR because I am a minimum wage earner as office clerk and my
income is far below in amount than that of my personal and additional exemption, which are deductible
from my taxable income and am also a solo parent as defined under Section 3(a) of the Solo Parents
Welfare Act of 2000 as I am a parent left solo or alone with the responsibility of parenthood due to
abandonment of spouse for almost ten (10) years now.

6. I am executing this affidavit to attest to the truth of the foregoing facts and for the legal purpose it may
serve.

IN WITNESS WHEREOF, we have hereunto set our hands this June 27, 2017 at Ormoc City,
Philippines.

HAZEL MAE S. LEGASPI

Affiant

SUBSCRIBED AND SWORN to before me June 27, 2017 in Ormoc City, Philippines.

ATTY.ADELITO M. SOLIBAGA JR.

Notary Public for the City of Ormoc,
Municipalities of Kananga, Matag-ob,
Merida and Isabel.
NCNo.ORM-15-12-017 issued on 12/ 17/15
Valid until December 31, 2017
Doc. No. ________; PTR No. 5108989, 01/03/17, Ormoc City
Page No. _______; IBP No. 1030929, 01/03/17, Cebu City
Book No._______ Roll of Attorney No. 51625
Series of 2017. TIN 207-693-130
J. Navarro St., Ormoc City