Republic of the Philippines )
Municipality of Sasmuan ) S.S.
Province of Pampanga
AFFIDAVIT OF UNDERTAKING (SOLO PARENT)
I, __________________________________________, of legal age, Filipino, with address at
_________________________ ________________________________________, after having been sworn in
accordance with law, hereby depose and state:
I am applying for the benefits provided under the Solo Parents Welfare Act of 2000.
I am a solo parent as defined under Section 3(a) of the Solo Parents Welfare Act of 2000 as I am a (Please
put a tick mark on the appropriate box provided below):
woman who has given birth a result of rape and other crimes against chastity even without final
conviction of the offender: Provided, that I keep and raise the child;
parent left solo or alone with the responsibility of parenthood due to death of spouse;
parent left solo or alone with the responsibility of parenthood while my spouse is detained or is serving
sentence for a criminal conviction for at least three (3) months;
parent left solo or alone with the responsibility of parenthood due to physical and/or mental incapacity
of spouse as certified by a public medical practitioner;
parent left solo or alone with the responsibility of parenthood due to legal separation or de facto
separation from spouse for at least six (6) months, as long as I am entrusted with the custody of my
child/children;
parent left solo or alone with the responsibility of parenthood due to declaration of nullity or annulment
of marriage as decreed by a court or by a church as long as I am entrusted with the custody of my
child/children;
parent left solo or alone with the responsibility of parenthood due to abandonment of spouse for at
least six (6) months;
any legal guardian, adoptive or foster parent who solely provides parental care and support to a child
or children;
spouse or any family member of an OFW, as defined in item (e) of this Section, of an Overseas Filipino
worker: Provided that the said OFW belongs to the low/semi-skilled worker category and is away from the
Philippines for an uninterrupted period of twelve (12) months: Provided, further, That the OFW, his or her
spouse, family member, or guardian of the child or children of an OFW falls under the requirements of this
section;
Any relative within fourth (4th) civil degree of consanguinity or affinity of the parent or legal guardian
who assumes parental care and support of the child or children as a result of the death, abandonment,
disappearance or absence of the parents or solo parent for at least six (6) months: Provided, That in cases
of solo grandparents who are senior citizens but who have the sole parental care and support over their
grandchildren who are unmarried, or unemployed and twenty-two (22) years old or below, or those twenty-
two (22) years old or over but who are unable to fully take care or protect themselves from abuse, neglect,
cruelty, exploitation, or discrimination because of a physical or mental disability or condition;
A pregnant woman who provides sole parental care and support to the unborn child or children.”
I undertake to inform the Solo Parent Office/Division of a change in my status or circumstance as a solo
parent within five (5) days from such change. I acknowledge that my eligibility to the benefits provided
under the Solo Parents Welfare Act shall immediately cease upon a change in my status of circumstance
as a solo parent; and
That I am not presently in cohabitation/co-parenting with anyone.
IN WITNESS WHEREOF, I have hereunto set my hand this October 18 2025 in the Municipality of
SASMUAN, Pampanga.
_________________________
Name of Affiant
ID:___________________________________
SUBSCRIBED AND SWORN to before me in the above-stated date in the Municipality of
SASMUAN, Pampanga. Affiant personally appeared and exhibited the above-mentioned evidence
of identity.
REPUBLIC OF THE PHILIPPINES )
MUNICIPALITY OF SASMUAN )
PAMPANGA ) S.S.
JOINT AFFIDAVIT OF TWO DISINTERESTED PERSONS (SOLO PARENT)
We___________________________and ________________________________, of legal age,
both Filipino citizens and with residence of
___________________________________________________, after having been duly sworn and
oath in accordance with law, hereby voluntarily depose and state that:
1. The we personally know_______________________ who resides at
______________________________________________________;
2. That he/she is not living with or receiving support from
_____________________/mother/Father of his/her child/ren for more than one year now;
3. That we are executing this Joint Affidavit to attest to the truth of all the foregoing
facts and for whatever legal purpose this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this October 18 2025 in the
Municipality of SASMUAN, Pampanga.
______________________________ ______________________________
Name of Affiant Name of Affiant
ID:_________________________ ID:_________________________
SUBSCRIBED AND SWORN to before me in the above-stated date in the Municipality of
SASMUAN, Pampanga. Affiant personally appeared and exhibited their corresponding
evidence of identity.
REPUBLIC OF THE PHILIPPINES )
MUNICIPALITY OF SASMUAN )
PAMPANGA )S.S.
AFFIDAVIT OF NO COHABITATION (SOLO PARENT)
I, ____________________________, Filipino, of legal age, and with residence at
___________________________________________________________, after having been duly sworn
in accordance with law, do hereby depose and state that:
1. That I am an applicant for the Issuance of a Solo Parent Identification Card
(ID)
2. That I am not cohabitating with a partner or a co-parent and I have a sole
parental care of my child/ren;
3. I execute this sworn attestation to attest to the truthfulness of the above
facts for whatever legal purposes it may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this October 18 2025 in the
Municipality of SASMUAN, Pampanga.
______________________________
Name of Affiant
ID:_________________________
SUBSCRIBED AND SWORN to before me in the above-stated date in the
Municipality of SASMUAN, Pampanga. Affiant personally appeared and exhibited their
corresponding evidence of identity.
REPUBLIC OF THE PHILIPPINES )
MUNICIPALTOY OF SASMUAN ) SS.
PROVINCE OF PAMPANGA )
AFFIDAVIT OF LOSS
I, ________________________________, Filipino of legal age, and a resident of
__________________________________________________, after having been duly sworn to in accordance
with law do hereby depose and state:
1. That I am a bona fide holder of a_____________________________________
Issued by ___________________________________________________________;
2. That recently, I looked for said item and I realized that it was missing as I could not
find it anymore from my belongings where I remembered to have kept it;
3. That despite diligence and best efforts to locate the same, it only proved futile and
the document is now beyond recovery;
4. That said _____________________________________
issued by _____________________________________ is now considered lost for all
purposes;
5. That to the best of my knowledge I did not alienate, mortgage or in any way
encumber said document;
6. That I am executing this affidavit to attest to the foregoing facts, and for whatever
legal purpose/s it may serve;
IN WITNESS WHEREOF, I have hereunto set my hand this October 18 2025 in the
Municipality of SASMUAN, Pampanga.
______________________________
Name of Affiant
ID:_________________________
SUBSCRIBED AND SWORN to before me in the above-stated date in the
Municipality of SASMUAN, Pampanga. Affiant personally appeared and exhibited their
corresponding evidence of identity.
REPUBLIC OF THE PHILIPPINES )
MUNICIPALITY OF SASMUAN ) SS.
PROVINCE OF PAMPANGA )
AFFIDAVIT OF PATERNITY AND FILIATION
I, ______________________________, male, Filipino, of legal age, and currently residing
at _____________________________________ Pampanga, after having been duly sworn to in
accordance with law do hereby depose and state:
1. That I am the biological father of my child ______________________________
born on _____________________________________
born in ___________________________________
and his/her mother is ____________________________________________;
2. That being the father of said child, I hereby acknowledge and recognize said child
as mine and my legal heir;
3. That I am allowing my child _____________________________ to use my surname to be
sad child’s surname in his/her Certificate of Live Birth;
4. That I execute this affidavit to attest to the truth of the above facts and for
whatever legal purpose this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this October 18 2025 in the
Municipality of SASMUAN, Pampanga.
______________________________
Name of Affiant
ID:_________________________
SUBSCRIBED AND SWORN to before me in the above-stated date in the
Municipality of SASMUAN, Pampanga. Affiant personally appeared and exhibited their
corresponding evidence of identity.
-
REPUBLIC OF THE PHILIPPINES )
MUNICIPALITY OF SASMUAN ) SS.
PROVINCE OF PAMPANGA )
AFFIDAVIT OF CONSENT TO USE FATHER’S SURNAME
I ___________________________, Female, Filipino, of legal age, and resident of
_______________________________________ Pampanga after having been duly sworn to in
accordance with law do hereby depose and state:
1. That I am the biological father of my child ______________________________
born on _____________________________________
born in ___________________________________
and his/her father is ____________________________________________;
2. I hereby express my conformity and consent for my said child to use her father’s
surname;
3. That I am executing this Affidavit to attest to the foregoing facts,
to enable my child to bear the surname of his/her father and for all legal
intents and purposes;
IN WITNESS WHEREOF, I have hereunto set my hand this October 18 2025 in the
Municipality of SASMUAN, Pampanga.
______________________________
Name of Affiant
ID:_________________________
SUBSCRIBED AND SWORN to before me in the above-stated date in the
Municipality of SASMUAN, Pampanga. Affiant personally appeared and exhibited their
corresponding evidence of identity.
Republic of the Philippines )
Municipality of Sasmuan ) S.S.
Province of Pampanga
AFFIDAVIT OF DISCREPANCY
I, ______________________________________, of legal age, Filipino, - resident of
_______________________________________________, after having been duly sworn in
accordance with law, hereby depose and state:
7. That my true and correct ___________________________________________
Is _________________________________________________________________;
8. That however, when I obtained my (record)____________________________
My__________________________________________________________________
Erroneously appeared as ____________________________________________;
9. That the error or discrepancy was caused by mere inadvertence;
10. That the________________________________________________________
With the following
information:_______________________________________________________
And I, are one and referring to the same person;
11. That I am executing this Affidavit of Discrepancy to attest
to the truth of the foregoing facts, to explain the discrepancy in my aforesaid
records and for whatever legal purpose/s this may serve;
IN WITNESS WHEREOF, I have hereunto set my hand this October 18 2025 in the
Municipality of SASMUAN, Pampanga.
_________________________
Name of Affiant
ID:___________________________________
SUBSCRIBED AND SWORN to before me in the above-stated date in the
Municipality of SASMUAN, Pampanga. Affiant personally appeared and exhibited the
above-mentioned evidence of identity.
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF PAMPANGA
MUNICIPALITY OF SASMUAN) SS.
AFFIDAVIT OF DENIAL
I, ______________________________________, of legal age, Filipino, - resident of
_______________________________________________, after having been duly sworn in
accordance with law, hereby depose and state:
1. That I was born on ________________________________________________;
2. My parents are _______________________ and ___________________________;
3. I established my residence in ___________________________________
Since ______________________ until the present;
4. That however, when I applied for a ____________________________, I was informed that
my namesake have a pending case, to wit:
Name Case No. /Offense charged Court/Agency
5. That I am not the same person referred to in the aforesaid case/s as I have never
been involved in nor charged of any crime;
6. That I execute this affidavit to deny any involvement in any crime and to clear my
name of whatever adverse records on file with the pertinent government Agency
and for whatever legal purpose/s this may serve;
IN WITNESS WHEREOF, I have hereunto set my hand this October 18 2025 in the Municipality of
SASMUAN, Pampanga.
_________________________
Name of Affiant
ID:___________________________________
SUBSCRIBED AND SWORN to before me in the above-stated date in the Municipality of
SASMUAN, Pampanga. Affiant personally appeared and exhibited the above-mentioned evidence
of identity.
REPUBLIC OF THE PHILIPPINES)
MUNICIPALITY OF SASMUAN )S.S.
PAMPANGA )
AFFIDAVIT OF GUARDIANSHIP
I, _____________________________, Filipino, of legal age, and a resident of
_________________________________________, Pampanga, after having duly sworn to in
accordance with law, hereby depose and say:
1. That I am ______________________________ of minor _____________________________ who
was born on _________________________________;
2. That said minor was _______________________________
________________________________________;
3. That the aforesaid minor/s live under my care and custody and I am the one who
provides FOR HIS/HER sustenance;
4. That I consider myself as Guardian of aforesaid minor/s;
5. That I am not an imbecile, vagrant, or vicious person or a habitual drunkard or a
habitual criminal and have not abandoned, neglected, or refused to support the
said minors or cause them to commit offenses against the law;
4. That I am executing this Affidavit of Guardianship to attest to the truthfulness of
the foregoing, and for whatever legal purpose/s this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this October 18 2025 in the Municipality of
SASMUAN, Pampanga.
_________________________
Name of Affiant
ID:___________________________________
SUBSCRIBED AND SWORN to before me in the above-stated date in the Municipality of
SASMUAN, Pampanga. Affiant personally appeared and exhibited the above-mentioned evidence
of identity.
REPUBLIC OF THE PHILIPPINES )
MUNICIPALITY OF SASMUAN ) SS.
PROVINCE OF PAMPANGA )
JOINT AFFIDAVIT OF COHABITATION
WE, ___________________________ (male) and _________________________ (female), both
single, Filipinos of legal age, and residents of
________________________________________________________________, after having been duly
sworn to in accordance with law do hereby depose and state:
1. We have been living together as husband and wife under the same roof,
continuously and without any interruption, from _________________________
until the present, or a total period of more than five (5) years;
2. During our cohabitation and even until the present, we remain both of
single status and, hence, there exists no legal impediment for us to marry
each other;
4. We are executing this affidavit to attest to the foregoing facts pursuant to
Article 34 of the Family Code and for whatever legal purpose this may serve.
IN WITNESS WHEREOF, I have hereunto set my hand this October 18 2025 in the
Municipality of SASMUAN, Pampanga.
__________________________________ __________________________________
Affiant Affiant
ID:__________________________ ID:___________________________
SUBSCRIBED AND SWORN to before me in the above-stated date in the Municipality of
SASMUAN, Pampanga. Affiant personally appeared and exhibited the above-mentioned evidence
of identity.
Philippines )
Province of Pampanga )
Municipality of Sasmuan) S.S.
JOINT AFFIDAVIT OF TWO DISINTERESTED PERSONS
We, _____________________________ and _______________________________________, both
residing in _____________________________________ Pampanga and both Filipinos of Legal
age, after having been duly sworn to in accordance with law hereby depose and say:
That we personally know _____________________________________ as well as her
parents since we were well-acquainted neighbors of
________________________________, Pampanga for more than ten ___ years;
That we personally know that ________________________’s mother is
__________________ and her father is ______________________;
That we personally know that ____________________ was born on __________________
in _________________ as we were aware every time she celebrated her birthday;
That the non-registration of her birth was could have been by mere inadvertence
and due to illiteracy;
That we are fully aware and cognizant of the above-stated facts;
That we are not related by consanguinity or affinity to said person;
That we are disinterested parties;
That we are executing this affidavit to the best of our knowledge and belief;
That we stand responsible to any suit that may arise against the veracity of our
statement hereinabove; and
That we are executing this affidavit to attest to the foregoing and for whatever
legal purpose/s this may serve;
AFFIANTS further sayeth no more.
IN WITNESS WHEREOF, we have hereunto set our hand this ____________ in the
Municipality of Sasmuan, Pampanga, Philippines.
___________________________ _______________________________
ID: ID:
ID No. ID No.
Affiants
SUBSCRIBED AND SWORN to before me in the above-stated date in the Municipality of
Sasmuan, Pampanga. Affiant personally appeared and exhibited the above-mentioned
evidence of identity
REPUBLIC OF THE PHILIPPINES )
MUNICIPALITY OF SASMUAN )
PAMPANGA )S.S.
AFFIDAVIT OF BARANGAY OFFICIAL
I, ____________________________, Filipino, of legal age, single/married/widow, and
presently residing at __________________________________________________, after having
been duly sworn in accordance with law, do hereby depose and state that:
1. I hold the position of __________________ of Barangay
__________________,_______________________, Pampanga;
2. That I have known _____________________________ for a reasonable period of time;
3. He/She is one of our constituents in the barangay who is a resident of
__________________________________________;
4. He/She is the ____________________ of ____________________ a minor;
5. He/She solely provides for all basic needs of said minor and he/she does not rely
for support from any other person;
6. He/She likewise in full custody of said minor
7. I am executing this affidavit to the truth of the foregoing facts for all legal intents
and purposes it may serve.
IN WITNESS WHEREOF, I hereby affixed my signature this ____ day of
_______________ in Municipality of Sasmuan, Pampanga.
_________________________
Affiant
SUBSCRIBED AND SWORN to before me, at the Municipality of Sasmuan,
Pampanga this ______________. The affiant whose identity I have ascertained, personally
signed the foregoing instrument before me and avowed under penalty of law to the
whole truth of the contents of said instrument.
