Republic of the Philippines )

City/Municipality of Villaba )
Province of Leyte ) S.S.
x-----------------------------------------------x

AFFIDAVIT

I, ANGIROSE E. TALLE, of legal age, Filipino, married, and a resident of Brgy.

Tagbubunga, Villaba, Leyte, Philippines, after having been sworn to in accordance with law,
hereby depose and state: THAT –

1. I hereby state under oath that I am a plain housewife and is NOT employed in any
capacity, either in private enterprise or government agency;

2. That I also state under oath that my husband, JONATHAN A. TALLE, is a fisherman;

3. That at present, my husband is receiving the amount of only One Thousand Five
Hundred Pesos (₱1,500.00) per month, more or less, as his income from his job as
fisherman;

4. That since I am just a plain housewife, I am not receiving any income from any
person or enterprise other than that given to me by the Department of Social
Welfare and Development (DSWD) as member of Pantawid Pamilyang Pilipino
Program or 4Ps, in the amount of One Thousand Seven Hundred Pesos (₱1,700.00)
per month, more or less;

5. I have read and understood the contents herein and swear under the penalty or
Perjury pursuant to Article 183 of the Revised Penal Code and other laws.

6. I am executing this Affidavit to attest to the truth of the foregoing and for the
purpose of applying for scholarship program with the Northern Leyte College (NLC),
Palompon, Leyte.

7. I also execute this Affidavit for whatever legal purpose that it may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 5 th day of February, 2020
in Villaba, Leyte, Philippines.

__________________________
ANGIROSE E. TALLE
Affiant

SUBSCRIBED AND SWORN TO BEFORE ME this 5th day of February, 2020, Affiant
exhibiting to me his/her 4Ps ID with No. 083751029-5248-00013
issued at DSWD, Villaba, Leyte, Philippines.

Doc. No. ______;

Page No. ______;
Book No. XI;
Series of 2020.