Republic of the Philippines )

City of Tacloban) S.S.

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

AFFIDAVIT OF GUARDIANSHIP

I, ------------------, of legal age, single, Filipino citizen, and presently residing at

Brgy. 62B Kalipayan St., Tacloban City, after having been duly sworn to in accordance
with law, do hereby depose and say:

1. That I am the aunt and guardian of my minor niece, ----------------------------------

born on September 13, 2006, 10 years old.

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

3. That I am competent to receive & request any document in behalf of the said
minor;

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 17th day of May,
2017 at Tacloban City, Philippines.

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Affiant
ID No. ------------------------------

SUBSCRIBED AND SWORN to before me this 17th day of May 2017 in

Tacloban City, Philippines, affiant exhibiting to me her competent evidence of identity
indicated below her name.

Doc No. : _____

Page No.: ______
Book No.: ______
Series of 2017